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Angelini A, Tiengo C, Cerchiaro MC, Soto F, Biz C, Messana F, Bassetto F, Ruggieri P. Ortho-oncoplastic surgery in foot and ankle: A narrative overview on reconstruction of soft-tissue defects after oncologic resections. Microsurgery 2024; 44:e31168. [PMID: 38549392 DOI: 10.1002/micr.31168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 01/20/2024] [Accepted: 02/28/2024] [Indexed: 04/02/2024]
Abstract
INTRODUCTION Malignant tumors of the foot are rare, and treatment strategies are challenging considering the complex anatomy of this area. In recent years, dramatic advances in technology and collaborations between different specialties (such as orthopedic, oncology, radiology, plastic, and vascular surgery) significantly changed the approach to complex malignant tumors without resorting to limb removal. The combination of the strengths of both orthopedic surgery and plastic surgery constitutes the modern definition of "orthoplasty." The aim of this review article is to provide treatment strategies that are available for reconstruction of foot and ankle in limb-salvage surgery after tumor resection, with a specific focus on microsurgical techniques in plastic surgery. METHODS We conducted a comprehensive search for relevant papers across PubMed, Scopus, Embase, and Web of Science. We included patient-based studies reporting on procedures for soft-tissue reconstruction with small and large soft tissue defects. Indications, pros and cons, and technique tips are discussed for each type of reconstructive technique. RESULTS The search was done using literature of the past 30 years (from 1990 to date), resulting in about 725 articles describing over 2000 cases. Cutaneous flaps included lateral supramalleolar flap, medial plantar flap, reverse sural neurocutaneous island flap, medial leg flap, and lateral leg flap. Free flaps included anterolateral thigh flap, radial forearm flap, latissimus dorsi flap, gracilis muscle flap, lateral arm flap, and rectus abdominis flap. CONCLUSIONS The orthoplastic approach in musculoskeletal oncology is a collaborative model of orthopedic and plastic surgeons working together, resulting in a higher rate of successful limb salvage in patients at risk for amputation. Protocols, biologic substitutes, and surgical techniques are largely improved in the last decades increasing the possibility of functional reconstruction. Microsurgical strategies represent the new frontiers in these demanding reconstructions.
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Affiliation(s)
- Andrea Angelini
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | - Cesare Tiengo
- Department of Plastic surgery, University of Padua, Padova, Italy
| | | | - Fernando Soto
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | - Carlo Biz
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
| | | | - Franco Bassetto
- Department of Plastic surgery, University of Padua, Padova, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padua, Padova, Italy
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Shiari R, Salar N, Parvneh VJ, Rahmani K, Yeganeh MH, Shiari S. Midfoot Arthritis in Children: Is There Any Relation With Malignancy? CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2020; 13:1179544120924643. [PMID: 32550767 PMCID: PMC7281876 DOI: 10.1177/1179544120924643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 11/15/2022]
Abstract
Background: Musculoskeletal symptoms are a presenting manifestation in a number of
lymphoproliferative disorders including leukemia, especially in children.
Among these primary symptoms, midfoot arthritis seems to be an important
alarm for malignancy in children. The aim of this study is evaluation
association of midfoot arthritis with malignancy in children. Method: In this cross-sectional study, all medical records of patients with arthritis
were identified and reviewed. All clinical and laboratory data were recorded
in the information form and data were analyzed by SPSS 25 software. Results: A total of 557 cases of arthritis were evaluated, of which 18 (3.2%) cases
have primary symptoms of midfoot arthritis. Four of 18 patients (22.2%) had
B-cell precursor acute lymphoblastic leukemia, that midfoot arthritis was
their first manifestation. Also, their laboratory findings confirmed that
platelet, lactic acid dehydrogenesis, and uric acid values were
significantly higher in these children. Based on statistical evaluation,
there was no significant difference between age and sex in these
patients. Conclusion: According to the findings of the present study, it can be concluded that
“midfoot arthritis” may be the first manifestation of leukemia in children
even with a near-normal hematologic values.
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Affiliation(s)
- Reza Shiari
- Reza Shiari, Department of Pediatric
Rheumatology, Mofid Children’s Hospital, Shariati Ave, Hossinieh Ershad,
15468-15514, Tehran, Iran.
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Kontogeorgakos VA, Eward WC, Brigman BE. Microsurgery in musculoskeletal oncology. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:271-278. [PMID: 30623252 DOI: 10.1007/s00590-019-02373-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/04/2019] [Indexed: 12/22/2022]
Abstract
Sarcomas are rare mesenchymal bone and soft tissue tumors of the musculoskeletal system. In the past, the primary treatment modality was amputation of the involved limb and the 5-year survival was very low for high-grade tumors. During the last three decades, limb salvage has become the rule rather than the exception and the use of neoadjuvant and adjuvant therapies (radiation and chemotherapy) has dramatically increased disease-free survival. Reconstruction of large bone and soft tissue defects, though, still remains a significant challenge in sarcoma patients. In particular, vascularized tissue transfer has proved extremely helpful in dealing with complex bone and soft tissue or functional defects that are frequently encountered as a result of the tumor or as a complication of surgery and adjuvant therapies. The principles, indications and results of microsurgical reconstruction differ from trauma patients and are directly related not only to the underlying disease process, but also to the local and systemic therapeutic modalities applied to the individual patient. Although plastic reconstruction in the oncological patients is not free of complications, usually these complications are manageable and do not jeopardize oncological outcome. The overall treatment strategy should be tailored to the patient's and sarcoma profile.
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Affiliation(s)
- Vasileios A Kontogeorgakos
- Department of Orthopaedics, National and Kapodistrian University of Athens, Rimini 1, Xaidari, Athens, Greece.
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Vaseenon T, Saengsin J, Pattamapaspong N, Settakorn J, Pruksakorn D. Spindle Cell Hemangioma of the Midfoot: A Case Report. J Orthop Case Rep 2017; 7:75-79. [PMID: 29242801 PMCID: PMC5728006 DOI: 10.13107/jocr.2250-0685.904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Spindle cell hemangioma (SCH) of the bone (midfoot) is a rare disease, but it can cause symptomatic pain and invade surrounding tissues lead to limb deformities and functional loss. Case Report We report the case of a 35-year-old woman who experienced a firm mass over the left midfoot for 5 years causing pain and numbness in the foot. Radiographs showed a geographic osteolytic lesion involving calcification of the base of the 2nd and 3rd metatarsals, cuneiforms bones and surrounding soft tissue. Magnetic resonance imaging revealed a lobulated mass in the midfoot containing tangles of tortuous blood vessels and dark foci characteristic of phleboliths. Wide resection of the 2nd and 3rd cuneiforms, metatarsal bones and surrounding tissues with a curved iliac bone graft reconstruction were performed. Histological assessment revealed a lesion composed of a vascular channel containing endothelial cells with smooth muscle but without cellular atypia. The definite diagnosis was spinal cell hemangioma. The pain resolved within 4 months. The foot was stable, and no recurrence was found at the 48 months follow-up. Conclusion This unusual disease, SCH of the midfoot responded favorably to wide resection and curved iliac bone grafting. It is suggested that this approach will provide a satisfactory functional result.
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Affiliation(s)
- Tanawat Vaseenon
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jirawat Saengsin
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nuttaya Pattamapaspong
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jongkolnee Settakorn
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Dumnoensun Pruksakorn
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Lesensky J, Nemec K, Kofranek I, Matejovsky Z. Autologous structural iliac bone grafts in reconstructions of short bone defects in the hand and foot after primary bone tumor resections: a single-institution retrospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:797-804. [DOI: 10.1007/s00590-017-1990-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/26/2017] [Indexed: 11/28/2022]
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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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Battiston B, Artiaco S, Piana R, Boux E, Tos P. Midfoot reconstruction with serratus anterior-rib osteomuscular free flap following oncological resection of synovial sarcoma. J Orthop Traumatol 2015; 16:347-50. [PMID: 25838161 PMCID: PMC4633423 DOI: 10.1007/s10195-015-0341-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 02/04/2015] [Indexed: 11/28/2022] Open
Abstract
During recent decades, the concept of surgical treatment of malignant bone and soft tissue sarcomas has evolved, with the aim of preserving limb function. In this paper we report a case of metatarsal reconstruction by means of serratus and rib free flap after excision of a synovial sarcoma located in the dorsal aspect of the midfoot. Five years after the operation, the patient was free from recurrence and recovered full foot function. Amputation has been widely used in the past and this procedure still remains a valuable option when limb salvage is not possible. Nevertheless, in selected cases, reconstruction by means of composite free flaps may be successfully used for limb preservation in the treatment of malignant foot tumors after surgical excision.
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Affiliation(s)
- Bruno Battiston
- III Orthopaedic Division, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Turin, Italy
| | - Stefano Artiaco
- IV Orthopaedic Division, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Via Zuretti 29, 10126, Turin, Italy.
| | - Raimondo Piana
- Oncologic Orthopaedic Division, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Turin, Italy
| | - Elena Boux
- Oncologic Orthopaedic Division, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Turin, Italy
| | - Pierluigi Tos
- Microsurgery Unit, Department of Orthopaedics and Traumatology, Orthopaedic and Trauma Center, Turin, Italy
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Unal MB, Seker A, Demiralp B, Sahin M, Cift HT, Oltulu I. Reconstruction of Traumatic Composite Tissue Defect of Medial Longitudinal Arch With Free Osteocutaneous Fibular Graft. J Foot Ankle Surg 2014; 55:333-7. [PMID: 25459091 DOI: 10.1053/j.jfas.2014.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Indexed: 02/03/2023]
Abstract
A 34-year-old male sustained a crush injury resulting in bone and soft tissue loss along the medial longitudinal arch of his left foot. Specifically, the injury resulted in loss of first metatarsal without injury to the medial cuneiform or proximal phalanx, fracture of the third metatarsal, and a 5-cm × 9-cm soft tissue defect overlying the dorsomedial aspect of the right foot. After debridement and daily wound care, the defect was subsequently reconstructed using a free osteocutaneous fibular graft. Approximately 6 months after reconstructive surgery, the patient returned to his job without pain, and his pedogram showed almost equal weightbearing distribution on both feet.
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Affiliation(s)
- Mehmet Bekir Unal
- Assistant Professor, Department of Orthopaedics and Traumatology, Istanbul Medipol University Medical Faculty, Istanbul, Turkey
| | - Ali Seker
- Assistant Professor, Department of Orthopaedics and Traumatology, Istanbul Medipol University Medical Faculty, Istanbul, Turkey.
| | - Bahtiyar Demiralp
- Professor, Department of Orthopaedics and Traumatology, Istanbul Medipol University Medical Faculty, Istanbul, Turkey
| | - Mustafa Sahin
- Assistant Professor, Department of Orthopaedics and Traumatology, Istanbul Medipol University Medical Faculty, Istanbul, Turkey
| | - Hakan Turan Cift
- Assistant Professor, Department of Orthopaedics and Traumatology, Istanbul Medipol University Medical Faculty, Istanbul, Turkey
| | - Ismail Oltulu
- Assistant Professor, Department of Orthopaedics and Traumatology, Istanbul Medipol University Medical Faculty, Istanbul, Turkey
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Kumar VS, Jalan D, Khan SA, Mridha AR. Aneurysmal bone cyst of medial cuneiform and a novel surgical technique for mid-foot reconstruction. BMJ Case Rep 2014; 2014:bcr-2013-201709. [PMID: 24563041 DOI: 10.1136/bcr-2013-201709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Aneurysmal bone cyst of the foot is extremely rare and the involvement of medial cuneiform has never been reported in the literature. In this report, we describe a 15-year-old boy who presented with a 6-month history of pain and swelling in his left foot. Radiograph demonstrated a lytic lesion in the medial cuneiform extending on to the middle cuneiform, the navicular bone and the base of the first metatarsal. En bloc resection of the lesion was performed using a dorsal longitudinal incision along the first ray. Tricortical iliac crest graft was harvested and shaped to fill the defect. Two drill holes were made and the tibialis anterior tendon was attached to the graft. Prepared, morcellised allograft was placed along the junction of autograft and host bone. At 1-year follow-up, the patient was pain free, the medial arch of the foot was maintained and the graft had united with the host bone.
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Reconstruction of metatarsal bone defects with a free fibular osteomyocutaneous flap incorporating soleus muscle. J Plast Reconstr Aesthet Surg 2013; 66:277-80. [DOI: 10.1016/j.bjps.2012.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 06/25/2012] [Accepted: 07/02/2012] [Indexed: 11/20/2022]
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Minimally invasive reconstructive surgery for complex oncologic foot defects in children. Plast Reconstr Surg 2011; 128:603-605. [PMID: 21788878 DOI: 10.1097/prs.0b013e31821eefec] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ozaki R, Hamada K, Emori M, Omori S, Joyama S, Naka N, Tomita Y, Araki N. Limb salvage operation using intraoperative extracorporeal autogenous irradiated bone and tendon graft for myxoid liposarcoma on dorsum of foot. Foot (Edinb) 2010; 20:90-5. [PMID: 20598521 DOI: 10.1016/j.foot.2010.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 06/03/2010] [Accepted: 06/04/2010] [Indexed: 02/04/2023]
Abstract
Foot and ankle sarcomas are conventionally treated with amputation. In this article, we report a case of myxoid liposarcoma on the dorsum of the foot treated by limb salvage operation with intraoperative extracorporeal autogenous irradiated bone and tendon grafts. The patient was a 76-year-old woman with a soft tissue tumor beneath the extensor tendons with attachment to the tarsal and metatarsal bones. The histological diagnosis was myxoid liposarcoma. Wide margin was achieved by splitting the tarsal and metatarsal bones into dorsal and plantar parts. The dorsal part of the bones and tendons was isolated from the resected material, irradiated ex-vivo and re-implanted into the host's bones and tendons. No local recurrence was detected around the irradiated bones and tendons during the follow-up at 36 months. The functional rating was 74% according to the ISOLS rating system. This method may be a better procedure for limb salvage operation of sarcomas on the dorsum of the foot.
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Affiliation(s)
- Ritsuro Ozaki
- Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3, Nakamichi, Higashinari-ku, Osaka 537-8511, Japan
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Strategies for managing massive defects of the foot in high-energy combat injuries of the lower extremity. Foot Ankle Clin 2010; 15:139-49. [PMID: 20189121 DOI: 10.1016/j.fcl.2009.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Blast-related lower extremity trauma presents many challenges in its management that are not frequently experienced in high-energy civilian trauma. Because many of the blasts experienced in the current conflicts are ground based, the foot and ankle have sustained considerable severity and extent of injury because of the proximity of the blast. The high functional demands required of active service members create several reconstructive challenges. The authors' experience in the current conflicts has shown a similar trend, with the magnitude of soft tissue injury usually dictating whether or not salvage may be possible. Several reconstructive options for bone defect management are outlined and discussed.
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Toriyama K, Kamei Y, Yagi S, Uchibori M, Nishida Y, Torii S. Reconstruction of the first and second metatarsals with free vascularised double-barrelled fibular graft after resection of a chondrosarcoma. J Plast Reconstr Aesthet Surg 2009; 62:e580-3. [PMID: 19136322 DOI: 10.1016/j.bjps.2008.11.062] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2008] [Revised: 10/31/2008] [Accepted: 11/09/2008] [Indexed: 11/29/2022]
Abstract
We report the case of a 71-year-old woman with a chondrosarcoma originating in the first metatarsal of the left foot. We performed a wide resection and reconstructed the first and second metatarsals with a free vascularised double-barrelled fibular graft. Her limb was successfully salvaged with functional and aesthetic results. Two years after surgery, the patient is able to walk without any ortho-prosthetic devices and has returned to farm work. The details of the technique applied in this case have been described in this article.
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Affiliation(s)
- Kazuhiro Toriyama
- Department of Plastic and Reconstructive Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya 466-8560, Japan.
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Yarmel D, Dormans JP, Pawel BR, Chang B. Recurrent pedal hobnail (Dabska-retiform) hemangioendothelioma with forefoot reconstructive surgery using a digital fillet flap. J Foot Ankle Surg 2008; 47:487-93. [PMID: 18725133 DOI: 10.1053/j.jfas.2008.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Indexed: 02/03/2023]
Abstract
UNLABELLED An 8-year-old female presented with a recurrent hobnail (Dabska-retiform) hemangioendothelioma of her right foot. After initial tumor excision and subsequent recurrence, the patient underwent a successful tumor resection and forefoot reconstruction using a fillet of second digit flap. In an attempt to create a plantigrade foot, while sufficiently removing this rare pedal tumor, the authors employed the use of a fillet of second digit flap. Specific surgical techniques and the histopathological assessment of this rare vascular neoplasm are discussed. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- Daniel Yarmel
- Foot and Ankle Surgical Program, Penn Presbyterian Medical Center, Philadelphia, PA 19104, USA.
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