New technique of surgical treatment of malignant calcaneal tumours. Preliminary report.
BACKGROUND
Malignant tumours of the calcaneus are very rare among children, constituting up to 3% of all bone tumours. This paper presents the outcome of a new technique of surgical treatment of malignant calcaneal tumours in the paediatric population involving the use of a large frozen allogeneic graft of the head of femur with a fragment of the femoral neck.


METHODS
Three patients were treated for primary malignant tumours of bone at our Department. The surgery was preceded by induction chemotherapy. A skin incision was made on the medial aspect of the foot. After the dissection of the calcaneus together with the tumour (Ennecking's wide resection), the defect was reconstructed with a frozen allogeneic bone graft. The graft was modelled and attached to the tarsal bone using metal clasps (arthrodesis). The Achilles tendon was also attached to the graft with metal clasps. A Redon suture was left in the floor of the wound. Single-layer sutures were placed in subcutaneous tissue and skin. The limb was immobilized in thigh plaster with the foot in 900 dorsiflexion.


RESULTS
The wound healed by first intention. Early post-operative complications were not observed, except for transient oedema of the surrounding tissues. The flexion and dorsiflexion movements were partially preserved. Local radical excision of the tumour was achieved in all the children. The graft healed into place. The patients are able to move without aid.


CONCLUSIONS
The use of a large allogeneic bone graft of the head of femur after excision of the calcaneus can assure very good long-term functional outcomes.
Woźniak
Wojciech
W
Klinika Chirurgii Onkologicznej Dzieci IMID, Warszawa. wwozniak@imid.med.pl
Raciborska
Anna
A
Walenta
Tomasz
T
Szafrański
Andrzej
A
Szymborska
Agnieszka
A
Bajor
Monika
M
D000293:Adolescent; D001859:Bone Neoplasms / Q000188:drug therapy / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods; D002111:Calcaneus / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D002813:Chondrosarcoma / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D012512:Sarcoma, Ewing / Q000188:drug therapy / Q000601:surgery*; D013584:Sarcoma, Synovial / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome