Proximal Tibia Resection

Proximal Tibia Resection

Carrie L. Heincelman

Megan E. Anderson

Operative Indications

  • Malignant tumors of the proximal femur—wide resection

Alternative Treatments

  • Rotationplasty

  • Through-knee or above-knee amputation


  • Plan for medial gastrocnemius flap ± split-thickness skin graft

  • Involvement of plastic surgeon


  • Supine

  • Pad prominences (sacrum, contralateral heel)

    • Long surgery and low body weight often contribute to high risk of decubitus ulcers

  • Small roll behind involved hip to position limb in slight external rotation, nearly neutral

  • Assess leg lengths in this position to restore this with reconstruction

    • Can place electrocardiogram (ECG) electrode on contralateral medial malleolus to aid in palpating under drapes

  • Gel bump to rest foot against with the knee in flexion

  • Drape entire extremity from lower abdomen and femoral triangle to toes (Figure 43.1)

Surgical Approach

  • Anteromedial

  • Extensile

  • Length of incision from just above patella to 2 to 5 cm distal to planned bone cut (depending on thickness of soft tissue envelope and size of soft tissue extent of tumor)

  • Surgeon on medial side of involved leg (reach across table) and assistant on same side as involved leg (Figure 43.2)

Technique in Steps

Initial Approach

  • Create full-thickness flaps (Figure 43.3)

    • Incise fascia over superficial posterior compartment

      • Keep intact entire length of wound for later repair (becomes part of retinaculum proximally)

      • Incise directly adjacent to medial border of tibia, but with enough tissue to cover soft tissue extent of tumor

      • Fascia on tibia will go with specimen; fascia preserved with soft tissue flap will aid in closure and decrease wound breakdown (Figure 43.4)

        • Bend knee with the posterior structures free (Figure 43.5)

        • Gastrocnemius falls away with gentle dissection

        • Release medial hamstrings at pes anserinus (Figure 43.6)

        • Identify tibial neurovascular bundle (NVB) in popliteal fossa

          • With large proximal and posterior soft tissue mass, release medial gastrocnemius at its origin on femur to access popliteal fossa (Figure 43.7)

Neurovascular Dissection

Jun 9, 2022 | Posted by in Reconstructive surgery | Comments Off on Proximal Tibia Resection

Full access? Get Clinical Tree

Get Clinical Tree app for offline access