Achilles tendon reconstruction with peroneus tendon transfer following epithelioid sarcoma resection: a rare case report at 5 years follow-up

Federica Mariotti,Silvio Caravelli,Massimiliano Mosca,Roberto Casadei,Simone Massimi,Stefano Zaffagnini

doi:10.1186/s40634-020-00233-x

Federica Mariotti, Silvio Caravelli + Show 4 more

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https://doi.org/10.1186/s40634-020-00233-x

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Abstract

BackgroundSoft-tissue sarcomas (STS) are rare in hand and foot. In this paper we present a case of reconstruction of Achilles tendon defect with peroneus brevis transfer reinforced with medial gastrocnemius fascia and plantaris tendon after excision of a local recurrence of epithelioid sarcoma.Case presentationFifty-five years-old female. MRI showed a lump of 5 × 2,5 × 2 cm into Achille’s tendon with invasion of the anterior fat tissue but no invasion of the surrounding bones. The patient underwent excision of the tumour and reconstruction of the tendinous defect with peroneus brevis transfer. Surgical technique has been widely described.Discussion and conclusionsEpithelioid sarcoma arising from the Achilles tendon is an extremely rare malignant tumour in an atypical site and may easily be confused with other soft tissue masses. It presents a technical challenge because of the large tendon defect remaining following wide resection. Reconstruction with peroneus brevis transfer, reinforced with medial gastrocnemius fascia and plantaris tendon, restore appropriate structural continuity and resistance. Functional results are satisfactory.

Highlights

Soft-tissue sarcomas (STS) are rare malignant mesenchymal tumours which arise in head, neck, retroperitoneum and limbs in most of the cases
Epithelioid sarcoma arising from the Achilles tendon is an extremely rare malignant tumour in an atypical site and may be confused with other soft tissue masses
In this paper we present a technical case of reconstruction of Achilles tendon defect with peroneus brevis transfer reinforced with medial gastrocnemius fascia and plantaris tendon after excision of a rare case of local recurrence of epithelioid sarcoma as an effective reconstructive strategy to obtain satisfactory functional results even after a wide resection as required

Summary

Introduction

Soft-tissue sarcomas (STS) are rare malignant mesenchymal tumours which arise in head, neck, retroperitoneum and limbs in most of the cases. They are rare in hand and foot [13]. Epithelioid sarcoma is a slow-growing lesion, more common in hand (58%) than foot (15%). It generally has a poor prognosis [6, 15, 16]. In this paper we present a case of reconstruction of Achilles tendon defect with peroneus brevis transfer reinforced with medial gastrocnemius fascia and plantaris tendon after excision of a local recurrence of epithelioid sarcoma.

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