Abstract
BackgroundAn understanding of the biology of bone and soft-tissue sarcomas, knowledge of adjuvant therapies and refinement in techniques of reconstructive surgery have allowed limb-sparing and limb salvage surgery to become a reality in the management of malignant tumors of the extremities. Functional limb salvage following radical resection has become a possibility in many resectable tumors by the use of alloplastic prostheses, homograft or autogenous bone for skeletal reconstitution combined with vascularized soft tissue coverage. Although the free fibula flap has been well described for reconstructions of the mandible and oral cavity, it has not been widely presented as an ideal tool to preserve extremities and to circumvent amputation.Patients and methodsWe describe the complex surgical reconstruction in four patients with primary sarcomas of the extremities. The sarcomas (Ewing's sarcoma, osteosarcoma and epitheloid sarcoma) were resected radically and the massive bone and soft tissue defect was replaced by vascularized free fibula transfer.ResultsWe present our experience with versatility of this osteocutaneous flap to allow reconstruction and salvage of extremitity sarcomas. There were no operative or postoperative complication and all the four patients had good limb function. The flap was found to be versatile as it could be used for either upper limb or lower limb and for large defects. The results were better in upper limb than in lower limb.ConclusionsFree fibular graft was found to be effective for salvaging limb function where a massive bone defect resulted from wide tumor resection in the extremities.
Highlights
We present our experience with versatility of this osteocutaneous flap to allow reconstruction and salvage of extremitity sarcomas
Free fibular graft was found to be effective for salvaging limb function where a massive bone defect resulted from wide tumor resection in the extremities
Common malignant tumors of the musculoskeletal system in children and young adults include Ewing's sarcoma and the osteosarcoma, osteosarcoma being the most frequent malignant neoplasm followed by Ewing's sarcoma
Summary
We describe here our initial experience with the treatment of bone tumors occurring in the extremities, which were treated after resection with a vascularized osteocutaneous fibular graft in four patients. X-Ray showed a 3.5 × 2.5 cm osteoblastic hyperdensity in the proximal humerus shaft (Figure 2a) This finding was verified by MRI-scan (Figure 2b) and a biopsy of the tumor confirmed the diagnosis of Ewing's sarcoma Grade IIb. Neoadjuvant chemotherapy, consisting of vincristin, actinomycin and cyclophosphamide, and an external radiation with a dose of 54 Gy was administered. Case – 4 Five years after a wide resection of an Ewing's sarcoma of the right femur, a young man presented with chronic osteomyelitis and non union of an allogenic bone graft at both docking sites. The allograft did not show any integration and a non-union at the proximal and distal end and a varus deformity of the leg had occurred (Figure 4a,4b) With these findings the allograft was removed, a radical debridement was performed, and the femur was fixed with a dynamic condylar screw and a plate. At present there is no evidence of an osteomyelitis, local recurrence or metastases
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