Soft tissue reconstruction with sagittal split anterior tibial muscle transfer and medial gastrocnemius transposition in limb-salvage surgery of bone tumors in a proximal tibia.

Twenty-six patients with bone tumors in a proximal tibia underwent limb-salvage surgery with custom prosthesis. The soft tissue reconstruction included gastrocnemius flap transposition to cover the upper part of the prosthesis and to reconstruct the extensor mechanism with its muscle fascia intact, in conjunction with sagittal split anterior tibial muscle transfer to provide soft tissue coverage of the lower part. The mean follow-up time was 43.0 months. One patient had deep infection. One patient had marginal skin necrosis and delayed healing. The average Musculoskeletal Tumor Society system score was 26.0 (23-29). The average range of motion was 91.9 degrees (50-120 degrees) with 4.4 degrees (0-20 degrees) of average extension lag. Compared with the traditional method of medial gastrocnemius transposition, the combination of sagittal split anterior tibial muscle transfer and medial gastrocnemius transposition is a technically easier, less invasive method to provide satisfactory soft tissue coverage and reconstruction of the extensor mechanism with better functional results in limb-salvage surgery of a proximal tibia.