PMC3750817_01
Clinical preoperative images. (Top) Extensive scarring. (Bottom left) An unstable thigh with 90  of dorsal extension in the distal thigh secondary to the lack of an intact femur. The thigh is freely mobile to deforming forces. Anteroposterior radiographs of the right hip (bottom, middle) and the right knee joint (bottom, right) display the major bony defect.
eplasty13e43_fig1.jpg
PMC3750817_01_eplasty13e43_fig1.jpg
F1
She presented to the authors' institution at the age of 13 with a complex right thigh wound and an unstable lower extremity (Fig 1).
Intraoperative photographs. (Left) Before rotation, the vascularized tibiaplasty is shown with attached perfusion arteries and associated soft tissue. After amputation of the foot, excision of the fibula, and resection of the soleus and gastrocnemius muscles (middle), the tibia was rotated and internally fixed to the proximal femur (right).
eplasty13e43_fig2.jpg
PMC3750817_01_eplasty13e43_fig2.jpg
F2
Medial and lateral fasciocutaneous flaps were elevated (Fig 2, left). The foot was amputated at the tibiotalar joint, and the tibia was converted into a vascularized bone flap (Fig 2, middle).
Thirty months after surgery. There has been excellent healing of the right thigh with a functional hip joint (left). Anteroposterior radiographs show osteosynthesis of the distal tibia and proximal femur (middle) and the proximal tibia serving as the distal tip of the rotationplasty (right).
eplasty13e43_fig3.jpg
PMC3750817_01_eplasty13e43_fig3.jpg
F3
Osteosynthesis between the proximal femur and the distal tibia was achieved with an anterior internal 9-hole, 4.5-mm, narrow dynamic compression plate and a 5-hole, 4.5-mm, narrow dynamic compression plate (Synthes, West Chester, PA) placed 90  and lateral to the first plate (Fig 3, middle).