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

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.

Chimeric partial scapula and latissimus dorsi muscle flap for midfoot reconstruction: A case report

“…Moreover, the patient with the osteocutaneous radial forearm flap have to scarify his radial artery and take the risk of palmaris longus tendon exposure 6. In recent years, the free fibula flap and the peroneal perforator flap have been the “workhorses” of foot reconstructions 7–10, 20. The free fibula flap, described by Wei et al,21 can provide a bony segment of 20–26 cm with a longitudinal configuration, high vascularity and acceptable donor site morbidity 7, 8, 10, 20.…”

“…In recent years, the free fibula flap and the peroneal perforator flap have been the “workhorses” of foot reconstructions 7–10, 20. The free fibula flap, described by Wei et al,21 can provide a bony segment of 20–26 cm with a longitudinal configuration, high vascularity and acceptable donor site morbidity 7, 8, 10, 20. The peroneal perforator flap enables the surgeon to preserve the main artery in the lower leg 10.…”

“…The peroneal perforator flap enables the surgeon to preserve the main artery in the lower leg 10. Donor site morbidity, including the operative scar, is limited,7–10, 20 and most patients can resume their daily activities 17. However, a morbidity rate of 3–14% have been reported, including reduced ankle mobility, postoperative deformation of the big toe, transition peroneal nerve palsy, delayed wound healing at the donor site and varus instability of the knee joint 10, 17.…”

“…However, a morbidity rate of 3–14% have been reported, including reduced ankle mobility, postoperative deformation of the big toe, transition peroneal nerve palsy, delayed wound healing at the donor site and varus instability of the knee joint 10, 17. For lower extremity reconstruction, it is necessary to use the opposite leg to obtain an adequate pedicle, which may make rehabilitation more difficult 7–9, 10. The possibility of ongoing peripheral arterial occlusive disease must also be considered.…”

“…Developments in microsurgery include bony reconstruction,3–5 particularly with iliac crest bone flaps,3–5 radial osteocutaneous flaps,6 and fibula flaps 7–10. A muscular flap is commonly used for foot reconstructions,11–15 such as a gracilis or latissimus dorsi (LD) flap.…”