Calcaneal Reconstruction by Proximal Tibia Allograft Following Total Calcanectomy
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CASE REPORT
Calcaneal Reconstruction by Proximal Tibia Allograft Following Total Calcanectomy Suraj Hindiskere 1
&
Saurodeep Bhattacharjee 1 & Srinath Doddarangappa 1 & Pramod S. Chinder 1
Received: 25 May 2019 / Accepted: 12 December 2019 # Indian Association of Surgical Oncology 2019
Introduction Primary malignant bone tumour of the calcaneum is rare and constitutes about 3% of all bone tumours [1]. Due to its rarity, delayed diagnosis and inadequate treatment, local recurrence is common; literature with regard to the available surgical options and outcome is also limited [2,3]. Osteosarcoma, chondrosarcoma and Ewing’s sarcoma are the common malignant tumours of the calcaneum [4]. Malignant tumours of the calcaneum tend to perforate the cortex early in their course, becoming extra compartmental [5]. Below-knee amputation was previously considered the standard treatment, but with the advent of chemotherapy, advanced imaging and surgical techniques, limb salvage has become the treatment of choice for primary calcaneal malignancy [6,3]. Since majority of the tumour vicinity is free from important neurovascular structures, total calcanectomy is a viable option for malignant tumours of the calcaneum [7]. Different reconstructive methods like allograft, recycled autograft, prosthesis and vascularized osseous flaps have been described, with their respective advantages and disadvantages [8–11]. We report a novel technique of using a fresh-frozen proximal tibia allograft, for structural reconstruction of the hindfoot, following total calcanectomy.
Case Report A 29-year-old male was evaluated clinic-radiologically for pain and swelling over the outer aspect of the right heel. An incisional biopsy was performed elsewhere for an osteolytic, * Suraj Hindiskere [email protected] 1
Department of Musculoskeletal Oncology, HealthCare Global Enterprises Ltd (HCG) Hospital, No. 8, P. Kalinga Rao Road, Sampangiramnagar, Bangalore 560020, India
expansile lesion in the body of the right calcaneum and was referred to us as the biopsy was suggestive of a grade II chondrosarcoma. On radiological re-evaluation, a FDG avid permeative, destructive osseous lesion with stippled chondroid calcification, involving the body of the right calcaneum measuring approximately 4.8 × 5.3 cm (cm) with SUV of 10.3, was evident on PET-CT scan (Fig. 1). The lateral cortex was breached with signs of soft tissue extension. On MRI scan, the lesion was isointense on T1 and hyperintense on T2 imaging, with no signs of articular extension. Considering the extent of the lesion, he was planned for total calcaneal resection and reconstruction (Fig. 2). Under general anaesthesia and following preoperative antibiotic prophylaxis, patient was placed in left lateral decubitus position on the operating table. Curvilinear incision including the incisional biopsy scar was chosen over the lateral aspect of the right hindfoot. The subcutaneous tissue was dissected and separated from the underlying soft tissue tumour extension, maintaining adequate margin. Superio
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