Periosteal ostoesarcoma of the femur treated with modified capanna procedure: A case report

Abstract

Introduction Periosteal osteosarcoma is a rare type of primary bone tumor. A vascularized fibula graft incorporates this revolutionary approach with a traditional massive allograft to reconstruct large femur and tibia defects during oncological resection. A structurally competent reconstruction with improved vascular and osteogenic capacities with the ability to achieve lower rates of fracture, infection, and non-union is obtained by integrating the benefits of the separate components. Method A 16-year-old female diagnosed with periosteal osteosarcoma of the left shaft femur. We performed neoadjuvant chemotherapy, limb salvage surgery consists of surgical resection and reconstruction, followed by adjuvant chemotherapy post operatively. We used Capanna procedure to salvage the femur. Result Post-operative evaluation showed stable fixation clinically and radiologically. There is no complications observed during recovery, as both distal motor and sensory are normal eventhough the patient were still limited in the motion of the hip and knee at the time due to post-operative pain. Discussion Cappana procedure has been known as a novel surgical method that could decrease the risk of complications results from classic reconstruction method, such as fracture, non-union, and infection. Conclusion Modified Cappana procedure which introduce the use liquid nitorgen-recycled autograft from the resected affected bone as a peripheral shell supporting a centrally placed vascularized fibular graft to fill the massive bone defect left by surgical resection, had successfully performed in our patient whom previously diagnosed with periosteal osteosarcoma of femoral shaft.