Distal Tibia Resection and Reconstruction

This chapter addresses the surgical management and reconstruction of distal tibial tumors, a rare but challenging site due to its subcutaneous location, limited soft tissue coverage, and critical role in weight-bearing and ankle function. Historically managed by below-knee amputation, advances in chemotherapy, imaging, and reconstructive surgery have enabled limb salvage as the preferred approach in most patients. The chapter emphasizes the importance of meticulous preoperative planning, including MRI and vascular imaging, to define tumor extent, joint involvement, and resectability. Resection techniques are described with attention to safe osteotomy placement, neurovascular preservation, and options for intra-articular, extra-articular, or joint-sparing procedures. Reconstruction strategies are comprehensively reviewed, ranging from biological methods such as allografts, vascularized or nonvascularized fibular autografts, and recycled autografts, to nonbiological options including custom-made endoprostheses. Distraction osteogenesis is also explored as a biological alternative in selected cases. Each approach is analyzed for functional outcomes, complication risks, and long-term durability. By integrating oncological safety with reconstructive innovation, this chapter provides a structured guide to achieving stable, durable, and functional limb salvage following distal tibia resections.