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Salvage of foot with extensive giant cell tumour with transfer of vascularised fibular bone graft.

Tharayil J, Patil RK - Indian J Plast Surg (2011)

Bottom Line: After excision his foot was reconstructed with vascularised bone flap.Graft united early and showed excellent remodelling because of good vascularity.We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Lakeshore Hospital, Cochin, India.

ABSTRACT
Though giant cell tumor is not uncommon in young adults, simultaneous involvement of multiple mid-foot bones is very uncommon and very difficult to treat. For reconstruction of large segmental bony defects following tumour excision, free vascularized bone graft is an excellent surgical option. We report a case with extensive involvement of all the tarsal bones and metatarsal bases in a young adult. After excision his foot was reconstructed with vascularised bone flap. We were able to save his foot after a wide local excision and reconstruction with free fibula graft. Graft united early and showed excellent remodelling because of good vascularity. We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.

No MeSH data available.


Related in: MedlinePlus

Serial X-ray images. (a) X-ray image after 12 weeks following reconstruction. K-wires are in place. Fracture site has healed well. (b) X-ray image 7 months after the surgery. The patient had developed fractures in both struts, and both fracture sites have already united with good callus. (c) Lateral view at the same time. (d) Well-healed fracture site and good remodeling of grafts at 1 year. (e) One year and nine months following operation
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Figure 10: Serial X-ray images. (a) X-ray image after 12 weeks following reconstruction. K-wires are in place. Fracture site has healed well. (b) X-ray image 7 months after the surgery. The patient had developed fractures in both struts, and both fracture sites have already united with good callus. (c) Lateral view at the same time. (d) Well-healed fracture site and good remodeling of grafts at 1 year. (e) One year and nine months following operation

Mentions: The postoperative period was uneventful and the patient was discharged on the 10th postoperative day. He was advised bed rest for 6 weeks following which the external fixator frame was removed and the leg was put in a Plaster of Paris cast. Nonweight-bearing walking was allowed from the 3rd week onwards. The donor site healed primarily. X-rays were taken on the 2nd postoperative day to check alignment and, subsequently, every month for the first 6 months to look for bony union, followed by 3-monthly for the next 6 months to look for continued union and remodelling. At 4 months, the fractures healed uneventfully and the wires were removed [Figure 4a]. Gradual weight bearing was then started, which was supervised by the hospital physiotherapist. In spite of repeated warnings to discourage immediate full-weight bearing, the patient attempted premature full-weight bearing at his residence, which resulted in fracture of the grafted fibular strut [Figure 4b]. After radiographic evaluation, he was advised nonweight-bearing ambulation. The fracture eventually healed in another 2 months time with a hypertrophic callus [Figure 4c], but the remodelling continued for over a year and half forming a good weight-bearing platform [Figure 4d and e]. Although bone scan was not performed postoperatively, the fact that the bone graft united with the adjacent bones, i.e. 1st and 3rd metatarsals and remnant of calcaneum within 4 months, confirmed the vascularisation of the fibula graft.


Salvage of foot with extensive giant cell tumour with transfer of vascularised fibular bone graft.

Tharayil J, Patil RK - Indian J Plast Surg (2011)

Serial X-ray images. (a) X-ray image after 12 weeks following reconstruction. K-wires are in place. Fracture site has healed well. (b) X-ray image 7 months after the surgery. The patient had developed fractures in both struts, and both fracture sites have already united with good callus. (c) Lateral view at the same time. (d) Well-healed fracture site and good remodeling of grafts at 1 year. (e) One year and nine months following operation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111110&req=5

Figure 10: Serial X-ray images. (a) X-ray image after 12 weeks following reconstruction. K-wires are in place. Fracture site has healed well. (b) X-ray image 7 months after the surgery. The patient had developed fractures in both struts, and both fracture sites have already united with good callus. (c) Lateral view at the same time. (d) Well-healed fracture site and good remodeling of grafts at 1 year. (e) One year and nine months following operation
Mentions: The postoperative period was uneventful and the patient was discharged on the 10th postoperative day. He was advised bed rest for 6 weeks following which the external fixator frame was removed and the leg was put in a Plaster of Paris cast. Nonweight-bearing walking was allowed from the 3rd week onwards. The donor site healed primarily. X-rays were taken on the 2nd postoperative day to check alignment and, subsequently, every month for the first 6 months to look for bony union, followed by 3-monthly for the next 6 months to look for continued union and remodelling. At 4 months, the fractures healed uneventfully and the wires were removed [Figure 4a]. Gradual weight bearing was then started, which was supervised by the hospital physiotherapist. In spite of repeated warnings to discourage immediate full-weight bearing, the patient attempted premature full-weight bearing at his residence, which resulted in fracture of the grafted fibular strut [Figure 4b]. After radiographic evaluation, he was advised nonweight-bearing ambulation. The fracture eventually healed in another 2 months time with a hypertrophic callus [Figure 4c], but the remodelling continued for over a year and half forming a good weight-bearing platform [Figure 4d and e]. Although bone scan was not performed postoperatively, the fact that the bone graft united with the adjacent bones, i.e. 1st and 3rd metatarsals and remnant of calcaneum within 4 months, confirmed the vascularisation of the fibula graft.

Bottom Line: After excision his foot was reconstructed with vascularised bone flap.Graft united early and showed excellent remodelling because of good vascularity.We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic and Reconstructive Surgery, Lakeshore Hospital, Cochin, India.

ABSTRACT
Though giant cell tumor is not uncommon in young adults, simultaneous involvement of multiple mid-foot bones is very uncommon and very difficult to treat. For reconstruction of large segmental bony defects following tumour excision, free vascularized bone graft is an excellent surgical option. We report a case with extensive involvement of all the tarsal bones and metatarsal bases in a young adult. After excision his foot was reconstructed with vascularised bone flap. We were able to save his foot after a wide local excision and reconstruction with free fibula graft. Graft united early and showed excellent remodelling because of good vascularity. We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.

No MeSH data available.


Related in: MedlinePlus