Anterior tibial artery preservation during limb salvage surgery: a novel technique with possible functional benefits

Abstract

Author(s): Nizamudheen M Pareekutty, Vivek M Ananthakrishnamoorthy, Abhay K Kattepur, Satheesan Balasubramanian, Roopa Vazhayil, Ratheesan Kumbakara

Background: Limb salvage surgery (LSS) for the proximal tibial tumours is technically challenging due to the complex surgical and vascular anatomy. Anterior tibial artery (ATA) is generally ligated to facilitate further dissection during surgery. We describe a technique of ATA preservation and its implications on functional outcomes. Material and methods: Retrospective study of patients undergoing LSS for proximal tibial osteosarcoma from December 2009 to January 2018 in a tertiary cancer center was done. Demographic profiles, tumor characteristics, operative details, functional outcomes and recurrence rates were analyzed. Results: Twenty two patients were included. The median age was 12.5 years. ATA preservation was performed in 13 patients. Functional outcomes using the MSTS score was higher at three, six and twelve months post treatment in patients who had ATA preservation, although not statistically significant. Oncological outcomes were comparable. Conclusion: ATA preservation is a feasible option in patients with upper tibial osteosarcomas undergoing LSS. A statistically non-significant benefit in functional outcomes was achieved with ATA preservation.

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