Function after total calcanectomy for malignant tumor in a child: is complex reconstruction necessary?

Limb salvage surgery for calcaneal chondrosarcoma: A case report

BACKGROUND

Limb salvage surgery for calcaneal sarcomas remains challenging due to its poor compartmentalization. While below-knee amputation is still the standard choice of operative treatment, total calcanectomy with or without reconstruction was advocated. This report aims to analyze the clinical outcome of calcaneal reconstruction with cement and replantation in situ after the inactivation of tumor.

METHODS

We describe a 73-year-old male patient who suffered chronic pain and increasingly larger neoplasm in the left foot for about 3 years. Based on the results of percutaneous biopsy, a diagnosis of chondrosarcoma was made.

RESULTS

The patient underwent total calcanectomy, inactivation of calcaneus tumor, and reconstruction with cement. The Achilles tendon was detached through a Cincinnati incision. No adverse events occurred both during and after the surgery. At the last follow-up of 29 months, the patient claimed no pain, no evident limp, or any limitation of daily activities. Image examination, weight-bearing test, and MSTS score revealed a satisfactory result.

CONCLUSION

Calcaneal reconstruction with bone cement after total calcanectomy, inactivation of calcaneus tumor, and replantation in situ is likely to provide a feasible surgical choice and a satisfactory clinical outcome.

Entire calcaneus reconstruction with pedicled composite fibular growth plate flap in a pediatric patient

Traumatic calcanectomy is a complicated rare condition that results in chronic pain and loss of limb function as the calcaneus is crucial for bearing weight. For an adult, possible treatment options are limited to below knee amputation, bone grafts, and 3D prosthesis; however, for the pediatric population, therapeutic data are scarce. In this case report, the authors describe a technique that provides the possibility for hindfoot reconstruction while maintaining growth potential without traumatizing other anatomic regions. A 5-year-old patient presented in the emergency department after he accidentally slipped under a lawnmower, which resulted in full calcaneal amputation with large bone and plantar soft tissue defects from the medial to lateral malleoli. Four days later, reconstructive surgery was performed using a composite vascularized pedicle growth plate flap. The flap was based on the retrograde anterior tibial artery and consisted of the peroneus longus muscle and fasciocutaneous perforator flap to maintain soft tissue coverage. The calcaneus was reconstructed by a double barrel fibular transplant localizing the growth plate in the distal part of the neocalcaneus. Full consolidation of the fibular barrels was achieved and the growth plate was still open at the 8-year follow-up. The fibular transplant has acquired a similar shape to a calcaneus with symmetric flattening and opposite side angulation. The patient's lower extremity functional score was 78/80 points. Reconstruction of an amputated calcaneal bone is rare and complicated, especially for pediatric patients. Authors demonstrate treatment with a complex vascularized flap for sustained growth and good functional outcome in the long term.

Diagnoses, treatment, and oncologic outcomes in patients with calcaneal malignances: Case series, systematic literature review, and pooled cohort analysis

BACKGROUND AND OBJECTIVES

Malignant tumors of the calcaneus are rare but pose a treatment challenge.

AIMS

(1) describe the demographics of calcaneal malignancies in a large cohort; (2) describe survival after amputation versus limb-salvage surgery for high-grade tumors.

METHODS

Study group: a "pooled" cohort of patients with primary calcaneal malignancies treated at two cancer centers (1984-2015) and systematic literature review. Kaplan-Meier analyses described survival across treatment and diagnostic groups; proportional hazards modeling assessed mortality after amputation versus limb salvage.

RESULTS

A total of 131 patients (11 treated at our centers and 120 patients from 53 published studies) with a median 36-month follow-up were included. Diagnoses included Ewing sarcoma (41%), osteosarcoma (30%), and chondrosarcoma (17%); 5-year survival rates were 43%, 73% (70%, high grade only), and 84% (60%, high grade only), respectively. Treatment involved amputation in 52%, limb salvage in 27%, and no surgery in 21%. There was no difference in mortality following limb salvage surgery (vs. amputation) for high-grade tumors (HR 0.38; 95% CI 0.14-1.05), after adjusting for Ewing sarcoma diagnosis (HR 5.15; 95% CI 1.55-17.14), metastatic disease at diagnosis (HR 3.88; 95% CI 1.29-11.64), and age (per-year HR 1.04; 95% CI 1.02-1.07).

CONCLUSIONS

Limb salvage is oncologically-feasible for calcaneal malignancies.

Primary tumours of the calcaneus

The calcaneus is a rare location for the occurrence and development of primary tumour types. Clinicians are unfamiliar with calcaneal tumour types, which may result in a delay in diagnosis or a missed diagnosis, resulting in unnecessary morbidity and amputation. Heel pain and localized swelling of the ankle are the most common symptoms. X-ray is the first choice for a tentative diagnosis of a calcaneal tumour. The final diagnosis depends on a histological examination. The treatment of calcaneal tumour types varies depending on the Enneking system. The majority of patients with benign tumours heal, except for a few with a palindromia. For malignant tumours, the prognosis is comparatively poor, resulting in disability and a high rate of metastasis. This review describes the spectrum of calcaneal tumour types and specifically illustrates the epidemiology, symptomatology, imagology, histopathology and treatment options that may facilitate diagnosis and improve prognosis.

Total calcanectomy for metastasis of renal cell carcinoma in the calcaneus: A case report

We present a rare case of metastasis of renal cell carcinoma to the calcaneus in a 59-year-old man who presented with pain and inability to bear weight on the left foot 3 years after right nephrectomy for renal cell carcinoma. He successfully underwent en bloc resection of his right calcaneus with a limb salvage procedure, total calcanectomy without bony reconstruction. Histological findings identified the lesion as a metastasis originating from a renal cell carcinoma. Recent follow-up examination showed no recurrence. To the best of our knowledge, this is the first reported case to be treated with total calcanectomy for renal cell carcinoma metastasis.