SLR - September 2010 - Alissa Duncan

Reconstruction of the first and second metatarsals with free vascularised double-barrelled fibular graft after resection of a chondrosarcoma

Reference:  Toriyama, K., Kameii, Y., Yagi, S., Uchibori, M., Nishida, Y., Torii, S. ( 2009). Reconstruction of the first and second metatarsals with free vascularised double-barrelled fibular graft after resection of a chondrosarcoma. Journal of Plastic, Reconstructive and Aesthetic Surgery, 62(12), 580-583.

Scientific Literature Reviews

Reviewed by:  Alissa Duncan
Residency Program: University Hospital Richmond Heights/ OCPM

Podiatric Relevance:
This case study provides a review for forefoot reconstruction following metatarsal resection of a chondrosarcoma.  

Methods:
A 71-year-old female presented with a 3-month history of a mass to the left midfoot. T1 weighted magnetic resonance images were obtained which revealed a tumor originating from the first metatarsal with soft tissue extension involving the second and third metatarsals.  No evidence of metastasis was observed, and needle biopsy was obtained to confirm the diagnosis of chondrosarcoma.  Resection of the first through third metatarsals, partial resection of the cuneiform, along with a cuff of the plantar muscles and overlying dorsal skin was performed.  Reconstruction was performed using the ipsilateral fibula for a double-barrelled, osteocutaneous fibular flap with internal fixation. 

Results: 
At 3 months post-op, the bones had fused and internal fixation was removed.  Post-operative biomechanical examination demonstrated an ankle joint range of motion that had 10 degrees of dorsiflexion and 30 degrees of plantarflexion.  

Conclusions:
This article is valuable   in reviewing reconstructive possibilities following resection of chondrosarcoma in the midfoot.  The article suggests using a double-barrelled free vascularized fibular osteocutaneous graft for  reconstruction of the midfoot. This treatment modality allows the patient to return to activity without the use of ortho-prosthetic devices.

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