DOS Kongressen 2014 ·
245
Ewings´sarcoma of the calcaneus treated by
limb sparing surgery with calcanectomy and
reconstruction with a composite of an allograft
and a vascularised osteocutaneous fibula graft.
Werner Hettwer, Lisa Toft Jensen, Michael Mørk Petersen
Musculoskeletal Tumor Section, Department of Orthopaedic Surgery,
Rigshospitalet, University of Copenhagen; Department of Plastic Surgery,
Rigshospitalet, University of Copenhagen
Background:
Primary malignant bone tumours of the calcaneus are very sel-
dom. Due to poor possibilities to do surgery with wide margins in this region
and limited options for reconstruction after calcanectomy many orthopaedic
oncologists use amputation as the preferred surgical treatment.
Purpose / Aim of Study:
We present two cases of Ewings´sarcoma of the cal-
caneus treated with limb sparing calcanectomy and reconstruction with a com-
posite of an allograft and a vascularised osteocutaneous fibula graft.
Materials and Methods:
Case 1: a girl, almost 6 years old at the time of cal-
canectomy of the left calcaneous August 7th 2012. Case 2: a girl 16 years old
at the time of right calcanectomy October 16th 2013. Both patients received
pre- and post- operative chemotherapy because of Ewings ´sarcoma. In both
cases removal of the calcaneus was performed using a combined medial and lat-
eral incision. In case 1 a femoral head allograft was fitted to replace the removed
calcaneus, and in case 2 a calcaneus allograft was used. In both cases, with the
aim of obtaining arthrodesis, the allograft was fixed to the talus and cuboid bone
with Acutrak titanium screws. A distally pedicled osteocutaneous flap was used
for reconstruction of soft tissue, and a 5-6 cm piece of vascularised fibula bone
was fitted into the allograft and fixed using staples.
Findings / Results:
Case 1 was allowed weight-bearing in an ankle brace after
3½ months and full weight- bearing with-out brace 8 months postoperatively,
when the arthrodesis between allograft and talus was considered healed. Case
2 was allowed increasing weight-bearing in a ROM walker 7 months postop-
eratively, when the arthrodesis between allograft and talus was considered
healed.
Conclusions:
Limb sparing calcanectomy was feasible with reconstruction us-
ing a composite of an allograft and a vascularised osteocutaneous fibula graft.
192.
