Kamal Achmad Fauzi, Waryudi Agus, Effendi Zuhri, Kodrat Evelina
Department of Orthopaedic and Traumatology Cipto Mangunkusumo National Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Department of Orthopaedic and Traumatology Cipto Mangunkusumo National Central Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
Int J Surg Case Rep. 2016;28:176-181. doi: 10.1016/j.ijscr.2016.09.038. Epub 2016 Sep 28.
Prevalence of giant cell tumor (GCT) at atypical locations like bones of the feet are rare, seen in <1% of cases. GCT may have aggressive features, including cortical expansion or destruction with a soft-tissue component. Difficult diagnosis most often followed with complicated management and high recurrence rate remains a challenge that is rarely reported.
We presented a case of forty-six-year-old male patient with giant cell tumor of the right calcaneus Campanacci 3 with secondary aneurysmal bone cyst (ABC). Wide excision total calcaneoctomy, followed by reconstruction bone defect using femoral head allograft and soft tissue coverage with sural flap had been done.
Conservative surgery with careful curettage and placement of bone cement should be considered the treatment of choice when feasible. However, aggressive GCTs may require wide excision and reconstruction or may be amputation. We decided to do salvage surgery since: traditionally curettage is not possible, adequately wide resection of local tumor could be achieved, neurovascular bundle was not involved, and also bone and soft tissue reconstructions could be done. In addition, he refused for amputation.
Wide excision total calcaneoctomy, bone allograft reconstruction and soft tissue coverage with sural flap is a good option for surgical management in aggressive GCT of calcaneus instead of amputation.
骨巨细胞瘤(GCT)在足部骨骼等非典型部位的发病率很低,不到1%的病例会出现。GCT可能具有侵袭性特征,包括皮质膨胀或破坏并伴有软组织成分。诊断困难常常伴随着复杂的治疗,且高复发率仍然是一个鲜有报道的挑战。
我们报告了一例46岁男性患者,患有右侧跟骨Campanacci 3级骨巨细胞瘤并伴有继发性骨囊肿(ABC)。已进行了广泛切除全跟骨切除术,随后使用股骨头同种异体骨移植修复骨缺损,并采用腓肠肌皮瓣进行软组织覆盖。
可行时,保守手术并仔细刮除和植入骨水泥应被视为首选治疗方法。然而,侵袭性GCT可能需要广泛切除和重建,或者可能需要截肢。我们决定进行挽救性手术,原因如下:传统上无法进行刮除术,能够实现对局部肿瘤的充分广泛切除,神经血管束未受累,并且还可以进行骨和软组织重建。此外,他拒绝截肢。
广泛切除全跟骨切除术、骨移植重建以及采用腓肠肌皮瓣进行软组织覆盖,是治疗侵袭性跟骨GCT而非截肢的良好手术选择。