Free Fibular Graft Reconstruction Following Resection of Chondrosarcoma in the First Metacarpal

Abstract

Chondrosarcoma is most frequently present in the pelvis and long bones and rarely seen in the bones of the hand. Traditionally the treatment of choice for involvment of the hand is ray amputation, however this causes significant functional deficit if there is thumb involvement. There are limited cases in literature of resection of thumb chondrosarcoma with restoration of function. We present a case of high grade chondrosarcoma of the first metacarpal treated with resection and free fibular graft reconstruction. We report excellent functional outcome with this procedure.

Thumb Reconstruction with Arthrodesis to the Second Metacarpal following Sarcoma Excision

“…Iliac crest, fibular allograft, free fibular autograft, and distal ulna have all been described for reconstruction after tumor removal at the first metacarpal [ 1 , 5 , 7 , 8 ]. In these reports, the graft was secured to the trapezium or scaphoid proximally.…”

Serratus Anterior-Rib Flap for the Reconstruction of Complex Defects Involving the First Metacarpal

“…Soft tissue defect of 50cm 2 , absence of the first metacarpal bone and thumb extensors (Pellegrini 2005;Jones et al 2012;Georgescu and Ivan 2003b) 6. Requirement to reconstruct the first metacarpal, the long extensor tendon of the thumb, and skin defect (Pellegrini 2005;Jones et al 2012, Ariff et al 2015Georgescu and Ivan 2003b;Smith and Brushart 1985;Hein et al 2016;Ariff et al 2015;Lim and Babineaux 2016;Gosal et al 2015;Punyaratabandhu et al 2017;Dhinsa et al 2011)…”

“…-Identification, isolation, and preparation of the radial artery stump and the cephalic vein -Harvesting of a segment of the eighth rib together with two slips of the serratus anterior (SA) muscle -Insetting the compound flap in the defect -Bone fixation through a double arthrodesis of the rib segment with the base of the proximal phalanx and the trapezium using a 1.5 mm Kirschner wire -Reconstruction of the long extensor tendon of the thumb using the extensor indicis proprius tendon as a functional tendon transfer -Flap coverage with split-thickness skin graft Basit et al 2004;Calvert et al 1985;Maini et al 2011;Minhas et al 2010;Saikia et al 2011;Sanjay et al 1996;Dhinsa et al 2011). Defect coverage can be achieved using either local or free fascio-cutaneous or free muscle flaps.…”

“…Defect coverage can be achieved using either local or free fascio-cutaneous or free muscle flaps. The risks of possible partial or complete resorption, nonunion, stress fractures, and infections represent disadvantages of this method because the bone segment is a non-vascularized one (Dhinsa et al 2011). 2.…”

Complications related to harvest of the proximal end of the fibula: A systematic review

“…Free vascularized fibula grafts are commonly used for the reconstruction of bony defects in the head and neck, extremities, spine, and pelvis and avascular necrosis of femoral head . Most commonly, the mid‐portion of the fibula is harvested, with preservation of the proximal and distal articulations.…”