Oncologic Defects: Reconstruction Following Initial Treatment Failure

Twenty-nine-year-old woman, 4.5 months post-radical resection and reconstruction of the left tibia for an adamantinoma at mid-shaft. Margins were clear of tumor. The initial reconstruction, a free fibula anastamosed to the posterior tibial artery (end to end), failed and suppurated (coagulase-negative staphylococcus [CNS]), requiring serial debridements and skin grafts to bone and soft tissues, anteriorly. Secondary reconstruction consisted of a (Companacci and Zanoli, JBJS 48A:44, 1966) tibiofibular synostosis and long leg cast. At presentation, her extremity was flail and draining (Serratia, CNS). An angiogram disclosed tied off posterior tibial and peroneal arteries, an intact anterior tibial artery, and excellent runoff, distally.