Combined replacement of defect in the complex treatment of undifferentiated pleomorphic sarcoma of the distal tibia

Abstract

Replacement of large bones and soft tissues defects formed after radical removal of the tumor remains a topical issue in oncological orthopedics. Today the combined methods of large segmental defects replacing of bones and joints are distraction osteogenesis with bone autograft and APC (allograft prosthesis composite). The combination of techniques allows us to minimize the disadvantages and to use the advantages of each method. Many methods of primary soft tissue grafting are used to replace soft tissue defects depending on localization and spread of the tumor process. The problem of soft tissue reconstruction and restoration the function of joints and limbs is relevant. Objective: to present a clinical case of malignant tumor treatment of the distal tibia part with an integrated approach to the restoration of bone defects and soft tissues. Methods: a clinical case of undifferentiated pleomorphic sarcoma of the distal tibia T₂N₀M₀, stage II, clinical group II was described. The patient underwent replacement of the postresection defect of the distal tibia with an osteoarticular allograft and fascia-cutanoeus flap grafting in order to replace soft tissue defect in the lower third of the leg. Results: using osteoarticular allograft replacing technique reduced the risk of complications as opposed using bone allograft or prosthetic replacement separately. The application of massive complex soft tissue graft made it possible to obtain a positive surgical outcome of treatment in patients with malignant tumors of long bones. Conclusions: an integrated approach to the replacement of post-resection defects in long bones and soft tissues helps to preserve the patient's limb in case of malignant bone tumor. Key