title: Simultaneous reconstruction of the bone and vessels for complex femoral defect.
abstract: BACKGROUND
  Several methods have been reported for intercalary reconstruction of femoral defects. Of these, free vascularized fibula grafts (FVFG) are preferred because of their durability, bone-healing potential, and tolerance to infection. If the bone tumor invades the femoral vessels, simultaneous vascular reconstruction also becomes necessary and significant technical hurdles make limb salvage difficult.
  
  
  METHODS
  We present a 10-year-old girl who underwent limb-sparing surgery for a distal femur osteosarcoma. The femoral defect was 15 cm long, and the femoral vessel defect was 10 cm long. The femur was reconstructed with bilateral FVFG, and the femoral vessels were reconstructed with saphenous vein grafts. The grafts survived without vascular compromise, and the affected limb was preserved successfully.
  
  
  CONCLUSIONS
  Combined use of bilateral FVFG and autologous vein grafts makes limb-sparing surgery for a large osteosarcoma of the femur possible.
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 1040045, Japan. shimiyam@ncc.go.jp.
authors.forename: Shimpei
authors.initials: S
authors.lastname: Miyamoto
authors.affiliation: Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
authors.forename: Masahide
authors.initials: M
authors.lastname: Fujiki
authors.affiliation: Division of Orthopedic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
authors.forename: Nokitaka
authors.initials: N
authors.lastname: Setsu
authors.affiliation: Division of Orthopedic Surgery, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 1040045, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kawai
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D064592:Autografts / Q000098:blood supply*; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002945:Cisplatin / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D005269:Femur / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005360:Fibula / Q000098:blood supply / Q000601:surgery; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008727:Methotrexate / Q000627:therapeutic use; D020360:Neoadjuvant Therapy; D012516:Osteosarcoma / Q000000981:diagnostic imaging / Q000601:surgery*; D012501:Saphenous Vein / Q000601:surgery; D013524:Surgical Flaps / Q000098:blood supply; D014182:Transplantation, Autologous / Q000379:methods
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin; D002945:Cisplatin; D008727:Methotrexate
keywords: Bypass flap; Flow-through; Lateral circumflex femoral; Popliteal artery; Revascularization