{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T09:05:17Z","timestamp":1789290317441,"version":"build-2803163510"},"reference-count":0,"publisher":"Indian Orthopaedic Research Group","issue":"9","content-domain":{"domain":["jocr.co.in"],"crossmark-restriction":true},"short-container-title":["Jocr"],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:p>Introduction:\nEwing sarcoma of the tibial shaft in a very young child presents a significant limb-salvage challenge. Treatment requires effective local control while preserving limb function and accommodating future growth. Extracorporeal irradiation (ECI) with reimplantation is a biological reconstruction technique that utilizes the patient\u2019s own sterilized tumor-bearing bone.\n\nCase Report:\nWe present the case of a 4-year-old boy diagnosed with Ewing sarcoma involving the right tibial shaft. Staging investigations revealed localized disease with intense uptake on bone scan and a small, non-specific 2-mm pulmonary nodule. Following a multidisciplinary team decision, the patient was treated with neoadjuvant chemotherapy according to the Children\u2019s Oncology Group AEWS0031 protocol, followed by limb-salvage surgery.\n\nConclusion:\nThis case demonstrates that en bloc resection with ECI and reconstruction, combined with free vascularized flap coverage, is a viable and effective limb-salvage strategy for extensive Ewing sarcoma in very young children. This complex single-stage procedure provides durable biological reconstruction, addresses large soft-tissue defects, and offers the potential for long-term function and growth.\n\nKeywords:\nEwing sarcoma , tibia , limb salvage , extracorporeal irradiation , biological reconstruction , anterolateral thigh flap , pediatric orthopedic oncology<\/jats:p>","DOI":"10.13107\/jocr.2026.v16.i09.7986","type":"journal-article","created":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T12:00:55Z","timestamp":1788609655000},"page":"58-64","update-policy":"https:\/\/doi.org\/10.13107\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Limb Salvage for Entire Tibial Ewing Sarcoma in a 4-year-Old Child Using Extracorporeal Irradiation and Free Flap Reconstruction: A Case Report and Surgical Technique"],"prefix":"10.13107","volume":"16","author":[{"given":"Ali H.","family":"Alyami","sequence":"first","affiliation":[{"name":"1 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia 2 Department of Orthopedic Surgery, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia 3 King Abdullah International Medical Research Center, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abaad Saad","family":"Althagafi","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgey, International Medical Center,Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rawan Hameed","family":"AlRashed","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghufran","family":"Aljawi","sequence":"additional","affiliation":[{"name":"1 College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia 3 King Abdullah International Medical Research Center, Jeddah, Saudi Arabia 5 Princess Noorah Oncology Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia 6 Department of Radiation Oncology, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasir","family":"Barakati","sequence":"additional","affiliation":[{"name":"3 King Abdullah International Medical Research Center, Jeddah, Saudi Arabia 5 Princess Noorah Oncology Center, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia 6 Department of Radiation Oncology, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramh","family":"AlGarni","sequence":"additional","affiliation":[{"name":"College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"5271","published-online":{"date-parts":[[2026]]},"container-title":["Journal of Orthopaedic Case Reports"],"original-title":[],"deposited":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T08:45:24Z","timestamp":1789289124000},"score":1,"resource":{"primary":{"URL":"https:\/\/jocr.co.in\/wp\/2026\/09\/limb-salvage-for-entire-tibial-ewing-sarcoma-in-a-4-year-old-child-using-extracorporeal-irradiation-and-free-flap-reconstruction-a-case-report-and-surgical-technique\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":0,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026]]},"published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.13107\/jocr.2026.v16.i09.7986","relation":{},"ISSN":["2321-3817"],"issn-type":[{"value":"2321-3817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"Research Article","name":"content_type","label":"Content Type"},{"value":"Yes","name":"crosschecked","label":"CrossChecked"},{"value":"Yes","name":"peer_reviewed","label":"Peer Reviewed"},{"value":"10.13107\/jocr.2026.v16.i09.7986","name":"published","label":"Published"},{"value":"Creative Commons Attribution","name":"license","label":"License","explanation":{"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},"group":{"name":"rights","label":"Rights"}}]}}