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Wrist Joint Reconstruction With a Vascularized Fibula Free Flap Following Giant Cell Tumor Excision in the Distal Radius

Mays CJ, Steeg KV, Chowdhry S, Seligson D, Wilhelmi BJ - Eplasty (2010)

Bottom Line: Methods: A 47-year-old woman with GCT in the right distal radius presented with decreased range of motion secondary to pain.Confirmation of the GCT was made with radiographic imaging and biopsy.Conclusion: This case presents an example of successful excision of a GCT in the distal radius with a PRC and arthroplasty using a vascularized fibula free flap autograft.

ABSTRACT

Objective: Multiple therapeutic modalities exist for giant cell tumors (GCT) in the distal radius. The majority of GCTs are amenable to curettage, with the expanded lesions requiring a more radical approach. This case report examines the technique of managing a GCT that has extended beyond the boundaries of the cortex and into local tissues. The decision to use arthroplasty versus arthrodesis and the proximal fibular head as a vascularized free flap is discussed in reference to a patient requiring a proximal row carpectomy (PRC) secondary to tumor invasion. Methods: A 47-year-old woman with GCT in the right distal radius presented with decreased range of motion secondary to pain. Confirmation of the GCT was made with radiographic imaging and biopsy. The extensive invasion of the lesion required en bloc tumor resection with PRC and subsequent arthroplasty. Results: Treatment involved resection of tumor and PRC with arthroplasty using the proximal head of the fibula and reattachment of the radioscaphocapitate and ulnar carpal ligaments. Success was measured on functionality of the joint, viability of the flap, and the absence of tumor recurrence and pain. Conclusion: This case presents an example of successful excision of a GCT in the distal radius with a PRC and arthroplasty using a vascularized fibula free flap autograft. The patient remained pain-free, had no evidence of tumor recurrence, demonstrated 50% range of motion in the wrist, and 80% preoperative strength as expected following PRC.

Free fibula graft ready for fixation and vascularization to the radius defect.
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Figure 3: Free fibula graft ready for fixation and vascularization to the radius defect.

Mentions: The initial fibular flap incision and subsequent dissection were carried down to the peroneus longus and brevis muscles. An osteotomy was performed approximately 19 cm from the head of the fibula. Nutrient vessels were identified entering the fibula at 9, 12, and 15 cm from the fibular head. The fibula flap was harvested on the peroneal vessels (Fig 2). The free fibula flap was transferred to the wrist defect for fixation and the femoral collateral ligament and biceps femoris tendon were anchored to the lateral tibia to maintain knee stability (Fig 3).

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Wrist Joint Reconstruction With a Vascularized Fibula Free Flap Following Giant Cell Tumor Excision in the Distal Radius

Mays CJ, Steeg KV, Chowdhry S, Seligson D, Wilhelmi BJ - Eplasty (2010)

Free fibula graft ready for fixation and vascularization to the radius defect.
© Copyright Policy - open-access
Figure 3: Free fibula graft ready for fixation and vascularization to the radius defect.
Mentions: The initial fibular flap incision and subsequent dissection were carried down to the peroneus longus and brevis muscles. An osteotomy was performed approximately 19 cm from the head of the fibula. Nutrient vessels were identified entering the fibula at 9, 12, and 15 cm from the fibular head. The fibula flap was harvested on the peroneal vessels (Fig 2). The free fibula flap was transferred to the wrist defect for fixation and the femoral collateral ligament and biceps femoris tendon were anchored to the lateral tibia to maintain knee stability (Fig 3).

Bottom Line: Methods: A 47-year-old woman with GCT in the right distal radius presented with decreased range of motion secondary to pain.Confirmation of the GCT was made with radiographic imaging and biopsy.Conclusion: This case presents an example of successful excision of a GCT in the distal radius with a PRC and arthroplasty using a vascularized fibula free flap autograft.

ABSTRACT

Objective: Multiple therapeutic modalities exist for giant cell tumors (GCT) in the distal radius. The majority of GCTs are amenable to curettage, with the expanded lesions requiring a more radical approach. This case report examines the technique of managing a GCT that has extended beyond the boundaries of the cortex and into local tissues. The decision to use arthroplasty versus arthrodesis and the proximal fibular head as a vascularized free flap is discussed in reference to a patient requiring a proximal row carpectomy (PRC) secondary to tumor invasion. Methods: A 47-year-old woman with GCT in the right distal radius presented with decreased range of motion secondary to pain. Confirmation of the GCT was made with radiographic imaging and biopsy. The extensive invasion of the lesion required en bloc tumor resection with PRC and subsequent arthroplasty. Results: Treatment involved resection of tumor and PRC with arthroplasty using the proximal head of the fibula and reattachment of the radioscaphocapitate and ulnar carpal ligaments. Success was measured on functionality of the joint, viability of the flap, and the absence of tumor recurrence and pain. Conclusion: This case presents an example of successful excision of a GCT in the distal radius with a PRC and arthroplasty using a vascularized fibula free flap autograft. The patient remained pain-free, had no evidence of tumor recurrence, demonstrated 50% range of motion in the wrist, and 80% preoperative strength as expected following PRC.

View Similar Images In: Results  - Collection
View Article: PubMed Central -  PubMed
Show All Figures - Show MeSH
getmorefigures.php?pmc=2875920&rFormat=json&query=null&req=5