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Paul AJ, Shreemal BB, Titus VTK. Foot and Ankle Giant Cell Tumors Are Not so Aggressive After All: A Retrospective Study. J Foot Ankle Surg 2021; 60:176-181. [PMID: 33168446 DOI: 10.1053/j.jfas.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 07/01/2020] [Accepted: 07/08/2020] [Indexed: 02/03/2023]
Abstract
Giant cell tumors are most commonly seen around the knee and rarely around the foot and ankle. Therefore there is a paucity of data regarding the options of surgery, outcomes and recurrence of Giant cell tumors involving the foot and ankle. We retrospectively studied patients with Giant cell tumors of the foot and ankle from January 2009 to December 2017. We identified 19 (N = 19) patients with a minimum of 1-year follow-up. Their data was retrieved from the electronic database and analyzed. The mean follow-up period was 36.2 (range 12-96) months. On an average, the patients underwent 1.6 surgeries. The surgeries performed were extended curettage and bone graft/cement in 8 (42.1%) patients, excision and bone graft in 8 (42.1%) patients and excision and mega prosthesis in 3 (15.79%) patients. The most common complication was wound infection seen in 3 (15.79%) patients. None of the patients who underwent index procedure in our center (biopsy and surgery) had local recurrence. There were 9 (47.36%) patients with primary procedure elsewhere - 7 of them had no recurrence after surgery in our center. One (5.26%) amputation was eventually performed due to complications and not as a primary surgery. At the final review, all 19 (100%) patients with >1 year follow up were in remission. Local recurrence and wound infection were exclusively found in patients who presented to us after invasive procedures done elsewhere. With good surgical clearance, the uncommon presentations of foot and ankle Giant cell tumors can be treated to attain complete remission.
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Affiliation(s)
- Arun John Paul
- Resident, Department of Orthopedics, Christian Medical College, Vellore, Tamil Nadu, India.
| | - Bhim Bahadur Shreemal
- Assistant Professor, Department of Orthopedics, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vijay T K Titus
- Professor, Department of Orthopedics, Christian Medical College, Vellore, Tamil Nadu, India
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Yang QD, Mu MD, Tao X, Tang KL. Three-dimensional printed talar prosthesis with biological function for giant cell tumor of the talus: A case report and review of the literature. World J Clin Cases 2021; 9:3147-3156. [PMID: 33969102 PMCID: PMC8080752 DOI: 10.12998/wjcc.v9.i13.3147] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/29/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Giant cell tumors (GCT) are most commonly seen in the distal femur. These tumors are uncommon in the small bones of the hand and feet, and a very few cases have been reported. A giant cell tumor of the talus is rarely seen clinically and could be a challenge to physicians.
CASE SUMMARY We report a rare case of GCT of the talus in one patient who underwent a new reconstructive surgery technique using a three-dimensional (3D) printing talar prosthesis. The prosthesis shape was designed by tomographic image processing and segmentation using technology to match the intact side by mirror symmetry with 3D post-processing technologies. The patient recovered nearly full range of motion of the ankle after 6 mo. The visual analogue scale and American Orthopaedic Foot and Ankle Society scores were 1 and 89 points, respectively.
CONCLUSION We demonstrated that 3D printing of a talar prosthesis is a beneficial option for GCT of the talus.
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Affiliation(s)
- Qian-Dong Yang
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Mi-Duo Mu
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Xu Tao
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
| | - Kang-Lai Tang
- Sports Medicine Center, The First Affiliated Hospital of Army Medical University, Chongqing 400038, China
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Arnež ZM, Troisi L, Colavitti G, Papa G, Leuzzi S, Stocco C, Ramella V. Reconstruction of the Weightbearing Area of the Foot with Vascularized Chimeric Osteocutaneous Fibular Flap: A Case Report. J Foot Ankle Surg 2020; 59:128-130. [PMID: 31882136 DOI: 10.1053/j.jfas.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/03/2018] [Accepted: 10/11/2018] [Indexed: 02/03/2023]
Abstract
Damage to the weightbearing surface of the foot is a challenge for the reconstructive surgeon. The aim is to reconstruct the skeletal tripod and soft tissue, allowing the patient to walk normally. We report the case of a patient admitted with an acute right foot open fracture of the second, third, fourth, and fifth metatarsal bones. After debridement of all nonvital tissues, the patient required reconstruction of the metatarsal heads (third, fourth, and fifth) plus soft tissue coverage. We then performed a reconstruction with a free osteocutaneous fibular flap, insetting the bone perpendicular to the long axis of the metatarsal bones. This configuration allowed the reconstruction of the foot skeletal tripod. A second free flap, a thin radial forearm flap, was added during the revision surgery to improve the venous drainage of the skin paddle of the fibular flap and avoid tension after skin closure. At 1-year follow-up, the patient was able to walk entirely weightbearing on the forefoot, returning to her previous employment with no limitation in physical and recreational activities. To our knowledge, this is the first description of the use of a chimeric osteocutaneous fibular flap, oriented transversely, to reconstruct a complex bone/soft tissue defect after a traumatic loss of multiple metatarsal heads.
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Affiliation(s)
- Zoran Marij Arnež
- Professor, Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria "Ospedali-Riuniti" Trieste, Italy.
| | - Luigi Troisi
- Surgeon, Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria "Ospedali-Riuniti" Trieste, Italy; Surgeon, Department of Plastic and Reconstructive Surgery, Salisbury NHS Foundation Trust, Salisbury, United Kingdom
| | - Giulia Colavitti
- Surgeon, Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria "Ospedali-Riuniti" Trieste, Italy
| | - Giovanni Papa
- Professor, Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria "Ospedali-Riuniti" Trieste, Italy
| | - Sara Leuzzi
- Surgeon, Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria "Ospedali-Riuniti" Trieste, Italy
| | - Chiara Stocco
- Surgeon, Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria "Ospedali-Riuniti" Trieste, Italy
| | - Vittorio Ramella
- Surgeon, Department of Plastic and Reconstructive Surgery, Azienda Ospedaliera Universitaria "Ospedali-Riuniti" Trieste, Italy
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Zhang J, He WS, Wang C, Yan YG, Ouyang ZH, Xue JB, Li XL, Wang WJ. Application of vascularized fibular graft for reconstruction and stabilization of multilevel cervical tuberculosis: A case report. Medicine (Baltimore) 2018; 97:e9382. [PMID: 29504970 PMCID: PMC5779739 DOI: 10.1097/md.0000000000009382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Multilevel cervical reconstruction and fusion after cervical tuberculosis has always been a challenge. The current implantation materials for cervical fusion, including titanium mesh, cage, and plate are limited by its inferior biological mechanical characteristics and the properties of the metallic material. This has led to the increased risk of recurrent infection after surgery. In addition, the unique nature of tuberculosis infection results in the low rate of cervical fusion and high risk of recurrence. This case report presents 1 patient who suffered from long segmental cervical tuberculosis and had reconstruction surgery using a vascularized fibula graft. The patient had successful graft incorporation 3 months postsurgery and was followed-up for 30 months. In this review, we detail the advantages of using vascularized fibular grafts and compare it with other types of grafts.
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Affiliation(s)
| | - Wen-Si He
- Department of Spine Surgery, the First Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Cheng Wang
- Department of Spine Surgery, the First Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Yi-Guo Yan
- Department of Spine Surgery, the First Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Zhi-Hua Ouyang
- Department of Spine Surgery, the First Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Jing-bo Xue
- Department of Spine Surgery, the First Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Xue-Lin Li
- Department of Spine Surgery, the First Affiliated Hospital, University of South China, Hengyang, Hunan, China
| | - Wen-Jun Wang
- Department of Spine Surgery, the First Affiliated Hospital, University of South China, Hengyang, Hunan, China
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Abstract
Most of tumours of the foot are tumour-like (synovial cyst, foreign body reactions and epidermal inclusion cyst) or benign conditions (tenosynovial giant cells tumours, planta fibromatosis). Malignant tumours of the soft-tissue and skeleton are very rare in the foot and their diagnosis is often delayed with referral to specialised teams after initial inappropriate procedures or unplanned excisions. The adverse effect of these misdiagnosed tumours is the increasing rate of amputation or local recurrences in the involved patients. In every lump, imaging should be discussed before any local treatment. Every lesion which is not an obvious synovial cyst or plantar fibromatosis should have a biopsy performed. After the age of 40 years, chondrosarcoma is the most usual malignant tumour of the foot. In young patients bone tumours such as osteosarcoma or Ewing’s sarcoma, are very unusually located in the foot. Synovial sarcoma is the most frequent histological diagnosis in soft tissues. Epithelioid sarcoma or clear cell sarcoma, involve more frequently the foot and ankle than other sites. The classic local treatment of malignant conditions of the foot and ankle was below-knee amputation at different levels. Nowadays, with the development of adjuvant therapies, some patients may benefit from conservative surgery or partial amputation after multidisciplinary team discussions. The prognosis of foot malignancy is not different from that at other locations, except perhaps in chondrosarcoma, which seems to be less aggressive in the foot. The anatomy of the foot is very complex with many bony and soft tissue structures in a relatively small space making large resections and conservative treatments difficult to achieve. Cite this article: EFORT Open Rev 2017;2. DOI: 10.1302/2058-5241.2.160078. Originally published online at www.efortopenreviews.org
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Affiliation(s)
- E Mascard
- Necker University Hospital, 75015 Paris, France
| | - N Gaspar
- Department of Pediatrics, Institute Gustave Roussy, 94805 Villejuif, France
| | - L Brugières
- Department of Pediatrics, Institute Gustave Roussy, 94805 Villejuif, France
| | - C Glorion
- Orthopedic Surgery Department, Necker University Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - S Pannier
- Orthopedic Surgery Department, Necker University Hospital, 149 rue de Sèvres, 75015 Paris, France
| | - A Gomez-Brouchet
- Laboratoire d'anatomie et cytologie pathologiques, Institut Universitaire du Cancer de Toulouse- Oncopole, 1 avenue Irène Joliot-Curie. 31059 Toulouse Cedex 9, France
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