Reconstructive surgery in the treatment of congenital pseudarthrosis of the tibia in children using microsurgical techniques: Reconstruction or amputation?

BACKGROUND: Numerous methods are available for the treatment of congenital pseudarthrosis of the tibia, but none of them offers a 100% satisfactory result and does not exclude the development of repeated refractories. One of the treatment methods is vascularized transplantation of a fragment of the fibula into the position of the defect of the tibia. However, the achievement of consolidation of the bone fragments of the lower leg does not stop the series of interventions necessary to restore the function of the affected segment. Therefore, specialists were asked about the advisability of performing amputations as an alternative to long-term and multistage interventions. 
AIM: To analyze the results of the use of microsurgical techniques for the treatment of patients with congenital pseudarthrosis of the tibia and, using the example of a patient, to show the way of multistage reconstruction of the lower limb. 
MATERIALS AND METHODS: The results of the use of microsurgical techniques in the elimination of a defect in the bones of the leg in five patients with congenital pseudarthrosis of the tibia were analyzed. Age, sex, presence of type 1 neurofibromatosis, bone defect size, autograft size, duration of consolidation, osteosynthesis index, refractory, range of joint motion, and secondary deformities of the segments after consolidation were assessed. The course of the patient when performing severe reconstructive interventions to restore the weight-bearing capacity of the limb was described. Vascularized autograft transplantation was performed by a qualified microsurgical team. 
RESULTS: The mean age was 7.8 2.2 years. Boys predominated, and type 1 neurofibromatosis was detected in 60% of the cases. The average defect size was 8.8 1.6 cm, and the autograft size was 10.8 1.6 cm. The duration of fixation was 260 90 days, and the fixation index was 24.6 10.6 days/cm. In two cases, 1 year after the fibula transfer, refractories were noted at the bonegraft interface. In 100% of the cases, patients had fibrous ankylosis at the level of the ankle joint, with a loss of functional range of motion, and in 40% of cases, there were flexionextension contractures of the knee joints with an extension deficit of up to 20. For this observation period, 3 of 5 patients underwent additional surgical interventions to correct the deformities of the affected limb. 
CONCLUSIONS: The use of VFT in patients with congenital pseudarthrosis of the tibia allows restoring the integrity of the tibia. Multiple interventions performed on the same segment can lead to irreversible secondary changes in adjacent joints and loss of function of this limb.