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This is the first case report where two patients were under uniform denosumab administration protocol in diffuse sclerosing osteomyelitis (DSO) treatment and were closely monitored for 18 months. Objectives: This study aimed to describe the beneficial effects of denosumab in DSO treatment as well as pain relief and the significant lack of long-term use due to poorer outcomes after repeated use. DSO of the jaw is a poorly understood rare chronic disease the treatment of which is still very challenging despite a rapid development of medicine. Different medical treatments have been pro-posed without any significant long-lasting success. Bisphosphonates have offered substantial clinical benefit in DSO therapy, but due to harmful pharmacodynamic properties, denosumab therapy has been used to replace bisphosphonate therapy. Patients had a reduction in pain intensity with each subsequent application of denosumab but with less success than the first administration of de-nosumab. This case report has shown that denosumab could be a promising conservative treatment option for pain treatment in patients suffering from DSO., Opisane su dvije pacijentice s difuznim sklerozirajućim osteomijelitisom (DSO) mandibule koje su liječene denosumabom prema jednakom protokolu i praćene su 18 mjeseci. Cilj je bio opisati korisne učinke denosumaba u liječenju DSO-a, ali i slabije djelovanje na ublažavanje boli poslije dugotrajne primjene. DSO čeljusti nedovoljno je istražena rijetka kronična bolest čije je liječenje, unatoč razvoju medicine, još uvijek vrlo izazovno. Predloženim metodama ne postiže se značajan i dugotrajan uspjeh. Bisfosfonati su se pokazali korisnima u liječenju DSO-a, no zbog štetnih farmakodinamičkih svojstava potrebna je alternativna terapija. Ovaj prikaz slučaja pokazuje da se dvjema pacijenticama bol smanjila poslije aplikacije denosumaba čiji je najjači učinak uočen poslije prve primjene. Denosumab bi mogao biti opcija konzervativnog liječenja boli koja obećava kad je riječ o pacijentima s DSO-om.

Background Osteomyelitis (OM) in the jaw is an inflammatory disease of osseous tissue that begins in the medullary space and progressively expands to the cortical portion of the bone, the Haversian system, the periosteum and the overlying soft tissue. Despite advances in dental and medical care, OM persists and is of important concern in modern medicine. Active negative pressure is known to prevent post-operative hematoma; decrease the number of bacterial pathogens, accumulation of toxins, and necrotic tissue; and promote osteogenesis and angiogenesis with the use of a draining tube such as the Jackson-Pratt (JP) or Hemovac. The purpose of this study was to assess the effectiveness of decompression for the treatment of OM in the jaw. Methods This retrospective study included a total of 130 patients, 55 patients with sclerosing OM and 75 patients with suppurative OM were included. The radiographic bone densities expressed as a grayscale values (GSVs), were measured using an easy digitalized panoramic analysis (EDPA) method, processed on the conditional inference tree, generated by the R program® 3.2.3 with a probability of 96.8%. Rectangle annotation analysis of INFINITT PACS® (INFINITT Healthcare, Seoul, Korea) of 50 mm2 was determined as the region of interest (ROI). Student’s t-test and ANOVA were used to determine significance (p Results Significant changes was observed between radiographic bone density in the sclerosing type with drain and without drain at the six-month and one-year follow-up (p p Conclusion The OM groups with drain exhibited more enhanced bone density compared to the groups without drain at the six-month and one-year follow-ups. The drain insertion for decompression is effective for the management of sclerosing and suppurative OM. It is recommended to implement it for the management of OM.

Plasma cellular osteomyelitis is a chronic and recurrent non purulent bone inflammatory entity charactererized by abundance of plasma cells in the lesional bone. Is a recurrent, unifocal or multifocal disorder, which has an unknown etiology with clinical and radiographic features that may make it impossible to distinguish from other non-suppurative sclerosing osteomyelitis. This rare condition usually occurs in metaphysis of a long bone of chil dren or young adults. We report a case of PCO in a 64-year-old woman with intermittent diffused pain in the hal lux of the left foot after several nail avulsions and two surgical procedures on the distal phalanx. The histological study of the bone sample showed reactive sclerotic bone with plasma cells compatible with PCO. In spite of its infectious origin, as in the present case the causal agent is not always identified. Owing to rarity of entity, a clini cal diagnosis is usually not considered and a histopathological examination is essential to establish of a definitive diagnosis.

Garre's osteomyelitis is a distinctive type of chronic osteomyelitis associated with gross thickening of the periosteum of the bones and peripheral reactive bone formation resulting from mild irritation or infections. The condition is seen in children or young adults and the mandible is more affected than the maxilla in most cases. The following is a case report of a 10 year old boy having Garre’s osteomylitis of the mandible due to the long standing infection and improper treatment of a carious tooth. Keywords: Primary chronic osteomyelitis (PCO), Acute osteomyelitis (AO), Chronic osteomyelitis with peripheral periostites COPP.

Objective To compare the clinical efficacy of vancomycin calcium sulfate implantation and fenestration decompression in the treatment of sclerosing osteomyelitis. Method A retrospective analysis for 46 cases of sclerosing osteomyelitis were admitted to our department between June 2010 to June 2020. Twenty-one patients were treated with fenestration decompression, twenty-five patients were treated with vancomycin calcium sulfate implantation. The postoperative hospital stay, days of drainage tube placement, visual analogue scale scores, C-reactive protein and erythrocyte sedimentation rate were compared between the two groups. Results The visual analogue scale scores of both groups were significantly lower than before treatment (p < 0.05), but the difference between them was not statistically significant. Patients treated by vancomycin calcium sulfate implantation had shorter postoperative hospital stay and days of drainage tube placement compared to those treated by fenestration decompression (p < 0.05). C-reactive protein and erythrocyte sedimentation rate in both groups were significantly lower than before treatment, but the improvement effect of vancomycin calcium sulfate implantation was better (p < 0.05). Conclusion Both treatment methods can relieve pain effectively. Compared with fenestration decompression, vancomycin calcium sulfate implantation can shorten the treatment time effectively, control the infection better.

The patient presented in this study had a form of chronic sclerosing osteomyelitis (CSO) that is rarely reported in calvarial bones and has never been reported in the frontal bone in the literature. We aimed to contribute to the literature with this case study. In this study, we report a 14-year-old girl who presented with swelling and pain in the frontal bone and underwent treatment due to CSO. The patient had no history of trauma and chronic infection. We conclude that CSO should be considered in the differential diagnosis of the patients presenting with cranial swelling whose diagnosis cannot be established based on the radiological findings.

Background: Osteomyelitis (OM) of the jaw is usually caused by a chronic odontogenic infection. Decompression is the release the intraluminal pressure in the cystic cavity allowing gradual bone growth from the periphery. The aim of this study was to analyze the effectiveness of decompression in an OM jaw model.Methods: A 4-mm-diameter defect was made on mandibles of fourteen Sprague-Dawley rats and inoculated with S. aureus (20 μl of 1x107 CFU/ml) injection. Two weeks later, four groups were made as non-treatment (C1), only curettage (C2), curettage and decompression (E1), and curettage and decompression with normal saline irrigation (E2). After four weeks, each group was analyzed.Results: Most micro-CT parameters of C1 and C2 were significantly lower, and bone mineral density with bone volume was enhanced in E2. E1 and E2 groups in histology showed prominent bone healing with a significantly high number of osteocytes, E2 had the weakest expression of IL-6 compared to that of C1. TNF-α and OPN were expressed strongly in the E1.Conclusion: Decompression drains induced advanced bone healing compared to that of curettage alone in an OM jaw model. Therefore, it could be recommended to use decompressive drain for the enhancement of jaw OM management.

We report a rare case of a 27-year-old woman with Takayasu arteritis (TAK) complicated by diffuse sclerosing osteomyelitis. She first presented with sclerosing osteomyelitis of the right mandible without evidence of arteritis in the carotid arteries. Eight months later, she complained of left neck pain, and imaging studies revealed the presence of arteritis in the left carotid artery. She was diagnosed with TAK, and immunosuppressive treatment was initiated, which was effective for both the arteritis and the osteomyelitis. Osteomyelitis is an important complication of TAK and bone scintigraphy is useful for its detection.

Chronic osteomyelitis can be a protracted disease often caused by inadequate curettage, injudicious use of antibiotics, and unnecessary delay in treating infected teeth. Failure of treatment of the odontogenic infection may result in decreased vascularization of the affected tissues, walling-off the infected area by relative avascular tissue, the formation of sequestra or reactive sclerosis of the bone. Here, we report a case of sclerosing type of osteomyelitis with periosteal reaction as seen in a middle-aged woman, highlighting how inadequate curettage following a common procedure such as extraction could lead to an uncommon complication.

Archaeological excavations carried out at the castle of Monte di Croce near Florence brought to light a small cemetery complex belonging to the castle church, dated back to the 11th-12th centuries. An elite stone tomb contained the skeletal remains of a male aged 35-45 years with obvious pathology of the right tibia. The proximal metaphysis and the upper half of the diaphysis appear massively enlarged as a result of severe chronic periostitis. A transverse section illustrates complete obliteration of the medullary cavity by new spongy bone, with some large cavitations. The primary, but completely remodeled tibial shaft is still recognizable. This finding and the strong sclerotic reaction with some central cavitations rule out any form of bone tumor and indicate a chronic inflammatory disease. The morphological and radiological picture and the tibial localization suggest a diagnosis of chronic sclerosing osteomyelitis of Garré, a rare form of chronic osteomyelitis characterized by an intense periosteal reaction with little or no suppuration.

Rationale: Multiple diaphyseal sclerosis (MDS), known as Ribbing disease, is a rare congenital bone disease resulting from autosomal recessive inheritance. The case study involved a 22-year-old female patient who had been diagnosed with chronic sclerosing osteomyelitis due to lack of knowledge about MDS. Previous studies reported rarely on this condition. Patient concerns: A 22-year-old female with MDS was analyzed. Diagnoses: MDS is characterized radiographically by a fusiform widening of the diaphyseal portion of the long bones, which is caused by a thickening of the cortex with obstruction of the medullary cavity. The pathologies are observed utilizing diagnostic imagery and are often difficult to identify. Intervention: The patient was following a suggested regimen of oral celecoxib capsules at 200 mg/day for 6 days. Outcomes: The patient's diagnosis was revised to the rare condition of Ribbing disease by reviewing the clinical history and distinctive radiography images and because the symptoms were alleviated by celecoxib capsule. We also present a review of the literature on the diagnosis and differential diagnosis of MDS based on clinical and imaging features. Lessons: MDS is rare and may often be initially misdiagnosed as another type of sclerosing bone dysplasia, thus, it is important to be aware of the existence of MDS. Once MDS is suspected, differential diagnosis should be performed to exclude other sclerosing bone dysplasias, taking into account clinical history, distinctive radiographic appearance, distribution, and laboratory and histopathologic findings. Laboratory evaluation and pathologic findings are nonspecific but assist in excluding other diagnoses. More evidence is needed to illustrate the effectiveness of medical or surgical treatments for patients with MDS.

Complications of flexible nailing of pediatric femur fractures include angular and rotational malunions, leg-length discrepancy, and, in rare instances, infection. To our knowledge, the development of a sclerosing type of chronic osteomyelitis, which appears most similar to chronic sclerosing osteomyelitis of Garre', has not been reported as a complication of, or associated with, flexible nail fixation of a pediatric femur fracture.

We report a case of florid osseous dysplasia (FOD) in the right mandible in a 40-year-old woman with communication difficulty due to mental retardation. Swelling and a mixture of radiolucency and radio-opacity were observed in the right mandible on an X-ray image. The mass was adjacent to the inferior border of the mandible and there was a radiolucent layer between the mass and the surrounding normal bone. A definitive diagnosis could not be made by biopsy and follow-up was performed. The mass increased during the follow-up period and segmental resection was performed. Clinical, X-ray, and histopathological findings indicated a diagnosis of FOD associated with chronic sclerosing osteomyelitis. An evaluation of the therapeutic regimen for FOD associated with secondary infection in this case suggested that aggressive surgical treatment and histopathological examination are required in such cases.

Sclerosing osteomyelitis of Garre continues to be a puzzling entity, with a nonspecific clinical description and course, an obscure pathogenesis, and no consensus on a predictable and helpful method of treatment. The proposed treatment options according to the literature are observation, analgesics and NSAIDs, and bone curettage. Here we present a 15-year-old girl treated by resection of a 12 cm-long lesion after failed conservative treatment, followed by bone transport using a circular external fixator. This treatment method has not been described previously for this condition. The duration of bone transport was 3 months, and the total duration of the frame treatment was 12 months. After hardware removal, and at 2.5-year follow-up, the patient was asymptomatic and achieved good functional results. To the best of our knowledge, this is the first description of bone resection and transport for the treatment of this condition, even though it is well described for the treatment of chronic osteomyelitis and other conditions necessitating bone resection. On the basis of this case we suggest that resection and bone transport using a circular external fixator for the treatment of sclerosing osteomyelitis of Garre might be an effective and safe method. Of course, being a rare entity, large cohorts are difficult to obtain, and more data and longer follow-up are required to form a convincing recommendation. Level IV evidence.

We report the case of a 6 year old patient who started with abdominal pain and left sciatica, which did not improve after applying symptomatic treatment. A complete analytical and imaging study was performed, which showed a lesion in left S1 corresponding to Garre's chronic diffuse sclerosing osteomyelitis. The diagnosis was confirmed by biopsy of the lesion. Treatment was established with corticosteroids and anti-inflammatory drugs, obtaining a clinical improvement, although in the follow-up imaging tests 2 years after the onset of the symptoms, the lesion persists but with a significant reduction in its size.

Florid cemento-osseous dysplasia (FCOD) has been described as a condition that characteristically affects the jaws of middle-aged black women. This condition has also been classified as gigantiform cementoma, chronic sclerosing osteomyelitis, sclerosing osteitis, multiple estenosis and sclerotic cemental masses. It usually exhibits as multiple radiopaque cementum-like masses distributed throughout the jaws. Radiographically, FCOD appears as dense, lobulated masses, often symmetrically located in various regions of the jaws. Computed tomography, because of its ability to give axial, sagittal, and frontal views, is useful in the evaluation of these lesions. This article reports the case of a 45-year-old white man who was diagnosed with FCOD on the basis of clinical, radiographic, biochemical and histological findings. It is of major importance to realize that all dentists have a unique opportunity as well as ethical obligation to assist in the struggle against wrong dental treatments that might save patients dental health. This case report illustrates the point that periapical radiolucencies may represent benign fibro-osseous lesions that may be overlooked or result in unnecessary endodontic treatment. Key words:Florid cemento-osseous dysplasia, florid osseous dysplasia, fibro-osseous lesions.

Anamnese und klinischer Befund: Bei einem 35jahrigen, bislang gesunden Patienten fiel vor 7 Jahren, ohne vorhergehendes Trauma, eine Schwellung mit schmerzbedingter Bewegungseinschrankung im Bereich des rechten Sternoklavikulargelenkes auf. Untersuchungen: Als pathologischer klinisch-chemischer Befund wurde nur eine masig beschleunigte Blutsenkungsreaktion nachgewiesen. Radiologisch waren ausgepragte hyperostotische Veranderungen im Bereich des linken oberen Thoraxskelettes mit Synostose des Sternoklavikulargelenkes zu erkennen. Die histologische Untersuchung eines Biopsates der linken Klavikula ergab eine unspezifische chronisch-sklerosierende Osteomyelitis. Therapie und Verlauf: In den nachsten 6 Jahren entwickelten sich vollstandige Ankylosen beider Sternoklavikulargelenke sowie umfangreiche, teils prasternal, teils im vorderen Mediastinum gelegene Fibrosen, die zu einer oberen Einflusstauung mit Ausbildung eines kompletten Paget-von-Schroetter-Syndroms fuhrten. Zusatzlich waren erstmals Lymphome submandibular, im Bereich der Venae jugulares beidseits sowie mediastinal nachweisbar. Folgerung: Die sternoklavikulare Hyperostose ist eine wichtige Differentialdiagnose entzundlicher und maligner Prozesse am Sternoklavikulargelenk. History and clinical findings: A 35-year-old previously healthy man developed a painful swelling in the area of the left sternoclavicular joint (SCJ), restricting movement. There had been no history of trauma. Investigations: A moderately increased erythrocyte sedimentation rate was the only abnormal finding among the usual laboratory tests. Radiologically there were marked hyperostotic changes in the area of the left upper thoracic cage with synostosis of the SCJ. Biopsy of the left clavicle showed nonspecific chronic sclerosing osteomyelitis. Treatment and course: Over the next 6 years the SCJ became completely ankylosed and there were now extensive fibroses, some presternal and some in the upper mediastinum with thrombosis of the left subclavian, axillary and jugular veins causing inflow occlusion (Paget-von-Schroetter-syndrome). Lymph nodes in the region of the mandible, jugular veins bilaterally and mediastinum were noted for the first time, remaining unchanged in size over six months. Conclusion: Sternoclavicular hyperostosis is an important condition in the differential diagnosis of inflammatory or malignant processes of this joint.

Chronic sclerosing osteomyelitis caused by Chryseobacterium meningosepticum was observed in a woman with steroid use. Her chronic sclerosing osteomyelitis was cured with ciprofloxacin. English literature review found 4 cases of bone-joint infection due to C. meningosepticum. The implications of treatment with a fluoroquinolone were discussed.

A case of chronic sclerosing osteomyelitis of a deeply burned patient of 85% BSA is presented. The chronic sclerosing osteomyelitis could have developed from transosseous wire fixation or from septic central veinous thrombosis.

Summary: Primary chronic osteomyelitis of the mandible is a rare condition that presents with a long-standing chronic facial swelling over the mandible, pain with mastication, and trismus. With no clinically appreciated acute phase, the aetiology often remains unknown. Many patients achieve adequate symptom control with broad-spectrum antibiotics, hyperbaric oxygen therapy and surgical debridement, or decortication of bone sequestration. However, because of the rarity of primary chronic osteomyelitis and the extensive involvement of the mandible that can result, we present a case of a 32-year-old woman with chronic disease of the left mandible requiring a left hemimandibulectomy and fibular free flap reconstruction. Few such cases have been reported in the literature, which require such extensive resection and reconstruction to control long-standing symptoms.

We describe a case of chronic sclerosing osteomyelitis of Garre in a 50-year-old woman occurring in her right femur and presenting with uncontrolled pain. The patient was initially treated with intramedullary reaming of the femur, but 3 years later re-presented with similar symptoms. This required further reaming and intramedullary nailing, achieving good clinical outcomes and lasting pain relief at 8-year follow-up.

Introducción: La osteomielitis esclerosante crónica de Garré (OECG) es una entidad rara que afecta a niños y adultos jóvenes. El proceso de OEG se caracteriza por una respuesta osteoblástica marcada, que en general puede aparecer en huesos largos o mandíbula, si bien la descripción original fue en mandíbula. Caso clínico: Masculino de 14 años con historia de tumefacción en cara de una semana de evolución con signos inflamatorios y drenaje espontáneo de líquido purulento. Inicialmente fue tratado con antibióticos, debido a la presencia de un área de celulitis. Además se realizó drenaje del área abscedada y exodoncia. No hubo aislamiento microbiológico posterior. Dada la mala respuesta a la medicación antibiótica, se realizó una gammagrafía ósea que arrojó por resultado la hipercaptación de la rama maxilar, confirmándose luego el diagnóstico de OEG en la biopsia de hueso. Discusión: Pocos casos clínicos de Osteomielitis Crónica de Garré han sido reportados. La mayoría de los reportes coinciden que la OECG afecta a niños y adultos jóvenes. Las localizaciones más frecuentes son las regiones metafisiarias de los huesos largos y la mandíbula. La causa se desconoce, pero los hallazgos microscópicos suponen el posible origen infeccioso. Introduction: Chronic sclerosing osteomyelitis of Garre (GSO) is a rare entity that affects children and young adults. The GSO process is characterized by a marked osteoblastic response, generally appearing in the long bones or mandible, with the original description being of a case in the mandible. Case Report: A male patient aged 14 years with a one-week history of swelling of the face with inflammatory signs and spontaneous drainage of purulent liquid. He was initially treated with antibiotics due to the presence of an area of cellulitis. Drainage of the abscess and tooth extraction were also performed. No microorganism was isolated. In view of poor response to antibiotic therapy a bone scan was done that found increased uptake in the mandibullar ramus, with GSO later confirmed by bone biopsy. Discussion: Few clinical cases of Garre’s sclerosing osteomyelitis have been reported. Most agree that GSO affects children and young adults. The most common locations are the metaphyseal portions of the long bones and the jaw. The cause is unknown, but microscopic findings suggest a possible infectious origin.

Sclerosing osteomyelitis of Garré is a rare syndrome; the mandible is the most commonly affected bone segment in the cervicofacial region. This chronic disease is characterized by a nonsuppurative ossifying periostitis with subperiosteal bone formation, commonly reactive to a mild infection or irritation. The differential diagnosis must be made with similar clinical conditions with hard mandibular swelling associated with bony sclerosis. Presumptive diagnosis can be achieved by radiology, but such diagnosis must be confirmed by histology. The aim of therapy is to remove the cause when recognized, aided by an adequate antibiotic therapy. Clinical, radiographic, and histologic features are presented in this case report.

We describe the successful operative treatment of a patient with chronic sclerosing osteomyelitis of the femur in which en bloc resection was avoided. Therapy consisted of combined endoscopic, computed tomography and bone scan-guided fenestration and intramedullary reaming, with removal of all sclerotic zones and normalization of the cortical thickness. An adequate supply of oxygen to the area was ensured by improved vascularisation and the application of hydrogen peroxide. At the medium term follow-up no recurrence was seen, and hip and knee function was normal.

Two hundred fifty-five solitary and 42 multiple cases of fibro-osseous lesions of the jaws, and 74 cases of sclerosing osteomyelitis were studied clinico-pathologically, in order to discuss the entity of peculiar cemental lesion with sequester-like appearance, which occurs mainly in the mandibular molar area of over middle-aged females. Four allied lesions, including the sequester-like cemental lesion, were revealed. They were provisionally designated sequestrated cemental masses, cemental masses, focal cemento-osseous dysplasia, and periapical cemental masses respectively, because no entities that were consistent with them could be found in the classifications of World Health Organization (WHO). The above- mentioned peculiar cemental lesion was equivalent to sequestrated cemental masses, which consist of sclerotic cementum and/or osteocementum with inflammation. Cemental masses and periapical cemental masses were related to sequestrated cemental masses. Focal cemento- osseous dysplasia was considered to be a counterpart of lesion which had been recently reported by Summerlin et al. In consideration of similarity and continuity of the histological and clinical findings, the four allied lesions were thought to be arranged in a continuous spectrum of fibro-cemento-osseous dysplasia of the jaws, along with periapical cemental dysplasia and florid cemento-osseous dysplasia that are mentioned in the WHO classification.

We describe a 20-year-old woman with a 10-year history of Garre's chronic sclerosing osteomyelitis occurring in the fifth metatarsal bone of the left foot. Apart from the rarity, this case illustrates the difficulties in diagnosing and effectively treating this chronic non-suppurative bone infection.

Identical female twins with chronic sclerosing osteomyelitis of the mandible are presented. The diagnoses of both at the age of 12 years were based on typical history, and on clinical, radiographic, and histologic findings. High concentrations of IgA and IgG were detected in the serum of both patients, but deviations were not observed in other immunologic variables. The normally commensal organism, Propionibacterium acnes grew from a bone biopsy specimen from the mandible of one twin. No oral focus of the disease was confirmed in either case. We suggest that hereditary factors must have played a role in the pathogenesis of these cases of chronic osteomyelitis.

WOS: 000274324500010, PubMed ID: 20134219, Objectives: We evaluated long-term results of treatment including creation of a gutter and muscle transposition in patients with chronic sclerosing osteomyelitis (CSO). Methods: Between 1980 and 1996, 11 patients (5 women, 6 men; mean age 36 years; range 17 to 69 years) with CSO were treated with creation of a gutter and muscle transposition. Seven patients had femoral, and four patients had tibial involvement. The main complaint was pain. The patients were evaluated with respect to complaints and radiologically (Xray, computed tomography, and magnetic resonance imaging) after a mean follow-up of 12.4 years (range 6 to 24 years). Results: During the follow up period, all the patients remained symptom-free without the need for antibiotic treatment except for one patient with tibial involvement, whose pain recurred after five years. The patient's complaint disappeared following reoperation with the same technique. Histologic examination of surgical biopsies showed nonspecific changes consistent with low-grade chronic osteomyelitis. Cultures were negative in all cases. Control radiographies showed no progression of sclerosis. Computed tomography showed cortical bone formation surrounding the transposed muscle, and magnetic resonance imaging showed fatty degeneration in the transposed muscle, without any signs of active osteomyelitis. Conclusion: The aim of gutter creation and muscle transposition is to increase blood supply to the diseased bone segment, without the need for microsurgical interventions and secondary reconstructive procedures. Our long-term results show that this technique is efficacious in patients with femoral and tibial involvement.