Vascularised Fibular Graft Reconstruction Following Resection of First Metatarsal Osteosarcoma: Case Report
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CASE REPORT
Vascularised Fibular Graft Reconstruction Following Resection of First Metatarsal Osteosarcoma: Case Report Bibhuti Bhusan Borthakur 1 & Srinivas Bannoth 1 & Sumanjit Boro 2 & Joydeep Purkayastha 1 & Abhijit Talukdar 1 & Deepjyoti Kalita 1 Received: 31 January 2019 / Accepted: 24 March 2020 # Indian Association of Surgical Oncology 2020
Abstract Osteosarcoma of foot is a rare condition. Most common site of foot is calcaneum. Osteosarcoma of foot is usually not amenable to limb sparing surgery because of poor compartmentalization of tumour in the foot and subsequent need to amputate to achieve sound oncological margins. Vascularised fibular grafts have been recognised as an attractive choice for reconstruction. Here we present a case of osteosarcoma of first metatarsal treated by resection of tumour bearing first metatarsal and reconstruction with free vascularised fibular graft (FVFGs). Keywords Vascularised fibular graft . 1st metatarsal . Osteosarcoma
Introduction Primary osteosarcoma of foot is extremely rare. In this regard, Berlin (1984) noted malignant tumours in less than 1% of the 67,000 ft lesions that he reviewed [1]. It is associated with clinical features not typical of conventional osteosarcoma. Resection and salvaging foot is technically challenging. Given its ability to provide immediate structural support and vascularity free vascularised fibular graft has become attractive reconstructive option. Indication for free vascularised * Srinivas Bannoth [email protected] Bibhuti Bhusan Borthakur [email protected] Sumanjit Boro [email protected] Joydeep Purkayastha [email protected] Abhijit Talukdar [email protected] Deepjyoti Kalita [email protected] 1
Department of Surgical Oncology, a.k.azad road, gopinath nagar, Guwahati, Assam, India
2
Department of plastic surgery, Guwahati, India
fibular graft is segmental bony defects of greater than 6 to 8 cm, such seen in post-traumatic, tumour resection and post-infectious bone loss [2].
Case report Twenty-nine-year-old female with no known comorbidities, Eastern cooperative oncology group(ECOG) score 1 came with chief complaint of foot swelling for 6 months. Patient has history of trauma later which she noted swelling. Initially evaluated at local hospital and was later referred to Dr. B. Borooah cancer institute. On examination there was around 5 × 6 cm swelling on dorsum or right foot at first metatarsal area. Blood work up was with in normal limits except for serum alkaline phosphatase (206 u/l). X-ray right food was suggestive of expansile, lytic, destructive lesion of first metatarsal. Magnetic resonance imaging of lower limb was suggestive of approximately 5 × 3 cm lobulated T2 hyperintense lesion involving the first metatarsal shaft proximally, with cortical destruction with sparing of distal metatarsal. 99mTcmethylene diphosphate (MDP) whole body scan was suggestive of increased osteoblastic activity in first right metatarsal with uptake nowhere else. Contrast-enhanced computerised
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