SMW Supplementum 193 - Swiss Medical Weekly

15 S SWiSS Med Wkly 2012;142(Suppl 193) · www.smw.ch Free communications
Results/Case Report: A 10 year old male represented with pain in the
proximal tibia after a fall. A non-displaced pathological fracture at the
proximal tibia was seen, and a biopsy revealed an osteosarcoma.
The boy underwent neoadjuvant chemotherapy according to the
EURAMOS protocol, and then resection of the proximal tibia sparing
the epiphysis was performed. A custom made growing prosthesis
(Stanmore Implants) was manufactured. This uncemented HA-coated
growing prosthesis has a plateau which receives the remaining
epiphysis (of ca 1 cm thickness) and which allows the fixation of the
tibial plateau with screws. The extensor mechanism was reconstructed
using a medial gastrocnemius flap together with a split skin graft. The
soft tissues healed uneventfully, and adjuvant chemotherapy was
resumed 3 weeks postoperatively. Six months later, the prosthesis
was non-invasively lengthened using an external magnet. The patient
has full extension and walks without walking aids.
Conclusions: A non-invasive joint sparing growing prosthesis
represents a valuable alternative for young children with bone
sarcomas. Although technically certainly challenging, it leads to good
function, and the non-invasive growing can be performed on an
outpatient basis. However, the costs are high.
FM54
Functional Outcome of Patients with Inferior
Scapulectomy
Martin Reidy, Martin Reidy, Franziska Seeli, Bruno Fuchs
Uniklinik Balgrist
Introduction: Scapulectomies are rarely performed because there are
only few indications. Depending on the extent and location of a bone
tumor, partial scapulectomies can be performed. When the tumor is
located within the inferior scapula, this part can be resected while
maintaining the superior part and particularly the glenoid. Herein, we
report on three patients and the functional outcome after the resection
of a chondrosaroma of the inferior scapula.
Results/Case Series: Three patients with a mean age of 45 years
were diagnosed with a chondrosarcoma involving the inferior scapula.
All did involve the teres muscles as well as the infraspinatus and parts
of the subscapularis muscles, but not the scapular spine. All patients
underwent a posterior approach, and parts of the respective muscles
were en bloc resected with the tumor and the inferior scapula. All
resections were R0. The bone defect was not reconstructed, the
muscles were adapted as good as possible in their anatomic positions.
Passive mobilisation was used for six weeks. All wounds healed
uneventfully. At a mean follow-up of 12 months, MSTS and TESS
scores were obtained and revealed a normal shoulder function with
complete and symmetric ROM.
Conclusions: In contrast to partial resections of the scapula involving
the glenoid, patients with inferior scapular resections usually have a
very good or normal shoulder function subsequent to surgery.
FM55
Transabdominal Rectus Flap for Sacrectomy
Martin Reidy1 , Pietro Giovanoli2 , Matthias Erschbamer2 ,
Bruno Fuchs2 1Uniklinik Balgrist; 2University Hospital Balgrist,
Orthopedic Research and University Hospital Zurich,
Department of Plastic & Reconstructive Surgery
Introduction: Musculoskeletal tumors represent the main indications
for a sacrectomy. Depending on the dorsal extension of the tumor
locally, and the thin soft tissue coverage of the sacrum dorsally, the
surgeon is often forced to resect a large enough skin and subcutis
such that wound healing problems may result because of increased
tension on the soft tissues when primarily closed. We present herein
a patient for whom we used a transabdominal recuts flap which was
placed – after the resection of the sacrum – dorsally, with uneventful
wound healing.
Results/Case Report: A 48-year old female patient fell onto her
buttock with consecutive pain. Conservative initial pain management
followed. Because pain increased over 6 months, imaging was
performed and a huge mass originating from the sacrum (proximally
S2/3) and extending within the left gluteal muscle down to its insertion
at the dorsal femur was shown. An ultrasound-guided biopsy revealed
a chordoma. We used a combined antero-posterior approach, first
getting the rectum as well as the L5 nerve root on the left side off the
tumor as well as ligating a huge vena sacralis mediana. Before closing,
we harvested a pedicled rectus abdominis flap which was placed in
the depth of the pelvis. The patient was then turned, an extensile
approach was chosen to remove the muscular tumor extension en
bloc woth the sacrum. The sacrectomy was performed at S2. After R0
removal of the specimen, the pedicled rectus abdominis flap was
developed from posteriorly, and fixed to cover the defect. There was
uneventful wound healing. Because histology revealed one positive
lymph node as well as vascular invasion, we opted to proceed with
postoperative adjuvant proton therapy.
Conclusions: In case of large tumor extension dorsal of the sacrum
with much soft tissue involved, the placement of a transabdominal
pedicled rectus flap is a very helpful option to achieve full soft tissue
coverage. It additionally offers the advantage to free the tumor
intrapelvically from other organs, as well as safe control of the vessles.
FM56
3D assisted planning and performance of corrective
osteotomy at the distal radius
Andreas Schweizer1 , Ladislav Nagy1 , Philipp Fürnstahl2 1 2 Uniklinik Balgrist; ETH Zurich, Computer Vision Laboratory
Introduction: Malunions of the distal radius may lead to pain, reduced
range of motion, instability and joint degeneration justifying corrective
osteotomy. The procedure is challenging due to the minuteness of the
bone and the aimed accurateness of 1–2 mm for extraarticular and