Techniques of reconstructive surgery. Experience in reconstructing postoperative defects in children with forearm bone sarcomas. Case series

Abstract

Introduction. Osteosarcoma is an extremely malignant mesenchymal, highly differentiated tumor from bone tissue, proceeding aggressively, characterized by the rapid development of distant metastases. Ewing's sarcoma is not less complex disease, which can be explained by its biological characteristics, including aggressive course, a tendency to develop early hematogenous metastases and frequent relapses. The aim of the study – checking the possibility of complications, the level of restoration of functions according to the Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (МSTS) scales after endoprosthesis, and the installation of a spacer. Materials and methods. We analyzed clinical cases of 7 children aged 8 to 15 years, who received treatment at the N.N. Blokhin National Medical Research Center of Oncology, оf the Ministry of Health of Russia in the period 2013–2019. Osteosarcoma was diagnosed in 4 patients, and Ewing’s sarcoma in 3 patients. They underwent organ-preserving surgical treatment of the upper limb in one of three ways – endoprosthesis, placement of a spacer, and replacement with autologous bone on microvascular anastomoses. In the course of the study, a method was used to assess limb function according to the TESS and МSTS scales. Results. It was found that in the postoperative period in all patients, regardless of the applied method of organ-preserving surgery, the results varied within 1,4–1,5 on the TESS scale, and 91–95 % on the MSTS scale. Postoperative complications in the form of post-traumatic neuropathy and dislocation were identified in 4 patients. 1 patient had local recurrence, 1 patient was diagnosed for metastatic leisure of lung tissue. It should be noted that the condition of all patients is currently satisfactory, no lethal cases have been identified. Conclusion. We believe that the results of this study are promising. However, it is necessary to conduct a longer period of observation of patients and evaluate their 5-year survival.