Surgical treatment of Ewing’s sarcoma of the calcaneus in children
Kobys VL. 1, Fidelskyi VV. 2, Konovalenko VF.3 , Bovkun VM. 2, Bezverhy OM. 2, Ivasjuk OM. 1, Matyushok OF. 1, Dovzhenko MM. 1 1 Kyiv Cancer Center, Kyiv, Ukraine; 2 Institute of Experimental Pathology, Oncology and Radiobiology n.a. Kavetskyi R.E., Kyiv, Ukraine; 3 National Children’t Specialized Hospital “Okhmatdyt”, Kyiv, Ukraine
Introduction: Sarcoma of the calcaneus occurs in 1% of cases, so there are only isolated publications on its surgical treatment. Surgical treatment of Ewing’s sarcoma of the calcaneus includes: amputation of the limb, replacement of the calcaneus defect with an allograft, or a composite allograft and vascularized fibula, or a composite allograft and a vascularized segment of the ilium, or endoprosthesis of the calcaneum. The purpose of our study: to evaluate the effectiveness of organ-preserving reimplantation surgery of autoclaved calcaneus with vascularized fibula.
Materials and methods: Evaluation of surgical treatment of Ewing’s sarcoma of the calcaneus in 2 patients aged 13 and 16 years 6 and 1.5 years after surgery was carried out. Patients were treated according to the EE-99 protocol with preoperative radiation therapy. Before the diagnosis was established, treatment was carried out according to the program of acute hematogenous osteomyelitis with antibiotic therapy and the introduction of decompression needles. The operation consisted of removal of the calcaneus, harvesting of the fibula with a vascular pedicle, autoclaving of the calcaneus for 20 minutes at a temperature of 120°C, reimplantation of the calcaneus with the fibula on vascular anastomoses, metal osteosynthesis. The results: Gypsum immobilization lasted from 3 to 6 months. Recovery of gait occurred 6 and 9 months after the operation, respectively. There was no graft resorption. Patients move freely, although they have flat feet, which requires the use of insoles. Patients without signs of the disease remain under dispensary observation. Conclusions: Reimplantation of autoclaved calcaneus with vascularized fibula can be the operation of choice for total sarcoma lesions of calcaneus in child
