title: Pedicled Sensate Composite Calcaneal Flap in Children With Congenital Tibial Pseudoarthrosis.
abstract: BACKGROUND
  The preservation and functionality of a limb affected by a malformation (such as congenital pseudoarthrosis of the tibia) or a severely mangled lower limb in children, despite modern reconstructive techniques, remains challenging, often eventually requiring amputation to achieve a better outcome. The classical Syme and Boyd procedures are functionally better than transtibial (TT) amputation, but are not feasible for congenital tibial pseudoarthrosis. TT amputation delivers an excellent, effective, and functional stump that usually leads, after prosthetization, to a functional gait. Unfortunately, in some situations, particularly when amputation is performed conventionally, the stump is also associated with complications. Future surgical revisions are often needed, particularly in children, because of stump overgrowth.
  
  
  METHODS
  Between 2008 and 2010, three patients diagnosed with congenital pseudoarthrosis of the tibia associated with neurofibromatosis who were indicated for TT amputation with calcaneal flap after failure of all previous surgical reconstructive procedures were selected. The chosen method for osteosynthesis was an external fixator of Ilizarov.
  
  
  RESULTS
  At 12 weeks of follow-up, the stump had healed in all three patients, and tibiocalcaneal fusion was achieved without complications. All patients were prosthetized and had an asymptomatic gait. After a minimum follow-up of 6 years, all three cases with the pedicled sensate composite calcaneal flap still had a strong, full weight-bearing surface and have adapted easily to the conventional prosthesis, providing a painless stump with excellent functionality.
  
  
  CONCLUSIONS
  With a 0 rate of needed revisions, all 3 cases with the pedicled sensate composite calcaneal flap preserving the hind foot still have a strong, full weight-bearing surface and have easily adapted to the conventional prosthesis, providing a painless and excellent functional stump that could last a lifetime.
  
  
  METHODS
  Level IV.
authors.affiliation: *State Hospital of Sumare of the State University of Campinas, HES-UNICAMP †Paulo Sacramento Hospital, Jundiaí ‡The Department of Orthopedics and Traumatology Surgery of the State University of Campinas, UNICAMP, Maxsuelton Alves de Souza §The State University of Campinas, HC-UNICAMP, Campinas, SP, Brazil.
authors.forename: Mauricio L D
authors.initials: MLD
authors.lastname: Mongon
authors.forename: Fernando C
authors.initials: FC
authors.lastname: Ribera
authors.forename: Antonio M A
authors.initials: AMA
authors.lastname: de Souza
authors.forename: Aurelio L
authors.initials: AL
authors.lastname: Sposito
authors.forename: William D
authors.initials: WD
authors.lastname: Belangero
authors.forename: Bruno
authors.initials: B
authors.lastname: Livani
mesh_terms: D000671:Amputation, Surgical / Q000379:methods*; D000672:Amputation Stumps / Q000294:innervation*; D002111:Calcaneus / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain; D011542:Pseudarthrosis / Q000151:congenital* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013977:Tibia / Q000601:surgery*; D013978:Tibial Fractures / Q000151:congenital* / Q000601:surgery; D016474:Weight-Bearing