Objective To compare the cl inical effectiveness of the medial plantar flap, the retrograde posterior tibial vascular flap, and the reverse sural neurocutaneous flap in repairing defect caused by resection of cutaneous mal ignant melanoma (CMM) in the heel region. Methods The cl inical data were retrospectively analysed from 24 patients with defect who had CMM in the heel region and were treated by radical excision and flap repairing between March 2007 and March 2010. Defects were repaired with the reverse sural neurocutaneous flaps of 8 cm × 7 cm-14 cm × 12 cm at size in 12 patients (groupA), with the medial plantar flaps of 6 cm × 5 cm-8 cm × 7 cm at size in 7 patients (group B), and with the retrograde posterior tibial vascular flaps of 9 cm × 7 cm-15 cm × 13 cm at size in 5 patients (group C). There was no significant difference in gender, age, duration of illness, cl inical stage, and size of CMM among 3 groups (Pgt; 0.05). The donor site was sutured directly or by free skin graft. Results No significant difference was found in the operation time and the intraoperative blood loss among 3 groups (P gt; 0.05). All skin flaps or grafts survived and wounds healed by first intention. The patients were followed up 1-3 years. The flaps had normal texture and color with no ulcer in 3 groups. At 1 year after operation, the sensory recovery rates of the flaps were 0, 100%, and 20% in groups A, B, and C, respectively, showing significant difference among 3 groups (P=0.001). The patients had normal appearance of heel and pain-free walking [10 (83%) in group A, 6 (86%) in group B, and 4 (80%) in group C] of heel region, showing no significant difference among 3 groups (χ2=40.000, P=0.135). Heel pain existed in weightbearing walking of 3 groups, and there were significant differences in visule analogue scale (VAS) score (Plt; 0.05). There was no significant difference in range of motion of ankle joint among 3 groups (P gt; 0.05). Except 1 patiant of relapse in group A at 1 month after operation, no relapse was observed in the other patients during follow-up. Conclusion The medial plantar flap, the retrograde posterior tibial vascular flap, and the reverse sural neurocutaneous flap can achieve the good cl inical effectiveness in treating heel defect caused by the resection of CMM. And the medial plantar flap is the first choice in small skin defect of heel area.
Objective To analyze the effectiveness and application value of epiphysis preserving by the method of physeal distraction for treatment of femur osteosarcoma in children’s limb saving surgery. Methods Between January 2007 and January 2011, 6 patients with femur osteosarcoma underwent epiphysis preserving operation by physeal distraction. There were 4 males and 2 females with a mean age of 11.4 years (range, 9-14 years). The mean disease duration was 4.8 months (range, 1-9 months). The pathology confirmed osteosarcoma in all patients by core needle or open biopsy, including 1 case of osteogenic sarcoma, 1 case of chondroblastic osteogenic sarcoma, 1 case of osteoblastic osteogenic sarcoma, and 3 cases of no classified osteosarcoma. The clinical stage was IIA in 1 case and IIB in 5 cases according to the Enneking staging system. All patients received 2 cycles of neoadjuvant chemotherapy before operation. Then physeal distraction was performed for 4-7 days (mean, 5.7 days) based on Cantilde;adell technique. After 1-2 days of physeal distraction, massive allograft bones and interlocking intramedullary nails were used to reconstruct bone defect after tumor resection. All patients received another 4-6 cycles of chemotherapy and were followed up. Bone healing, limb discrepancy, and complications were recorded. Functional outcomes were assessed by the system of the Musculoskeletal Tumor Society (MSTS) and the range of motion (ROM) of both knee joints. Results Superficial infection occurred in 1 case and was cured after dressing change, and primary healing was obtained in the other patients. All 6 patients were followed up 2.5 years on average (range, 1-5 years). Symptoms of pain and swelling disappeared. No complication of allograft rejection, loosening or breaking of fixation occurred. No relapse or metastasis happened during follow-up. Bone healing was observed at the metaphysis junction in 5 cases at 6-9 months after operation and in 1 case at 14 months. Delayed union happened at the diaphysis junction in all patients. Different amount of callus formation was seen at the surface of diaphysis junction, but the fracture line remained clear at 12-48 months after operation. At last follow-up, limb discrepancy was 1-3 cm in 4 patients and 3-5 cm in 2 patients; 3 patients had compensatory scoliosis, and 2 patients had claudication. The MSTS score was 27.20 ± 1.92, showing significant difference (t= — 4.12, P=0.00) when compared with preoperative score (19.60 ± 2.74). The ROM of affected knee was (127.00 ± 17.89)°, showing no significant differences when compared with preoperative ROM (109.00 ± 12.45)° (t= — 1.84, P=0.10) and with ROM of normal knee (126.00 ± 9.62)° (t= — 0.11, P=0.92). Conclusion Limb saving surgery by physeal distraction can be used in young patients with open epiphyseal plate, which has the advantages of simple operation, good effectiveness, and less complications.
Objective To investigate the feasibility of the preservation of the epiphysis and joint function of the distal femur in children with osteosarcoma with epiphyseal distraction by external fixator. Methods Between July 2007 and May 2011, 6 children with osteoblastic osteosarcoma of the distal femur underwent epiphyseal distraction by external fixator, combined with tumor resection and repair with massive allograft bone transplantation to preserve the epiphysis and joint function of the distal femur. There were 4 boys and 2 girls, aged from 9 to 14 years (mean, 10.5 years). According to Enneking clinical staging, 4 cases were in stage II A and 2 cases in stage II B. According to San-Julian et al. typing for metaphyseal tumor invasion, 3 cases were in type I and 3 cases in type II. The size of tumor ranged from 6 cm × 4 cm to 12 cm × 9 cm. All patients received 2 cycles of COSS 86 chemotherapy before operation and 4 cycles after operation. Results Poor healing of incision was observed in 1 case because of rejection of allograft bone and good healing was obtained after the symptomatic treatment, healing of incision by first intention was achieved in the other children. All 6 cases were followed up 11 to 56 months (mean, 37.5 months). One case died of lung metastasis at 2 years after operation. X-ray films showed no complication of internal fixator loosening and broken or bone nonunion. According to the functional evaluation criteria of International Society of Limb Salvage (ISOLS) at last follow-up, the results were excellent in 3 cases, good in 2 cases, and fair in 1 case; the excellent and good rate was 83.3%. The length of operated limb was (62.97 ± 7.51) cm, showing significant difference when compared with that of normal limb [(64.03 ± 7.47) cm] (t=0.246 6, P=0.813 4). Conclusion On the premise of adaptable indication, effective chemotherapy, and thoroughly tumor resection, the epiphyseal distraction by external fixator can obtain satisfactory results in limb-length and limb function in children with osteoblastic osteosarcoma of the distal femur.