Free Fibula Flap for Metacarpal Bone Tumor Reconstruction in Pediatric Age Group


Çeçen S., Kavruk K., Okan M. U., Akın S.

12th Bapras Congress 2023, Konya, Türkiye, 13 - 16 Eylül 2023, ss.273-276

  • Yayın Türü: Bildiri / Tam Metin Bildiri
  • Basıldığı Şehir: Konya
  • Basıldığı Ülke: Türkiye
  • Sayfa Sayıları: ss.273-276
  • Bursa Uludağ Üniversitesi Adresli: Evet

Özet

Introduction

Aneurysmal bone cysts account for approximately 5% of benign bone tumors, but only 3% to 5% of all aneurysmal bone cysts occur in the hand. Hand lesions most commonly occur in the second decade of life, with males and females equally affected. Metacarpal involvement is more common than phalangeal involvement, and carpal lesions are rare.

A 6-year-old female patient applied to our policlinic with swelling around the 1st metacarpal bone of the right hand. Radiological imaging was consistent with an aneurysmal bone cyst. Radiological diagnosis has been verified pathologically by open biopsy. The decision to follow up has been made. However, a rapid enlargement had seen in the 6th month and 1st year. Total excision had been decided because of the threat to hand functions—reconstructive options and results were evaluated with parents. The aneurysmal bone cyst was excised and reconstructed with a free fibula flap. There were no complications in the postoperative follow-ups.

 

Discussion and conclusion

 

Enchondroma, periosteal enchondroma, osteochondroma, osteoid osteoma, chondromyxoid fibroma, osteoblastoma, unicameral bone cyst, aneurysmal bone cyst, and giant cell tumor of bone are the benign tumors of the upper extremity. Enchondroma is the most common bone tumor of the hand, and %90 of Enchondromas are seen on the hand. For most bone defects of less than 6 cm with a well-vascularized bed, adequate soft tissue cover, and absence of infection, a conventional cancellous or cortico-cancellous auto-graft is generally recommended. Cancellous bone has greater inductive capacity than cortical bone and should be used unless mechanical stability is required.

 

Unlike conventional bone grafts, vascularized bone remains alive and dynamic in its new site. Viable bone does not undergo creeping substitution; thus significant osteopenia does not occur. The result is improved strength, healing, and stress responsiveness compared with non-vascularized conventional bone grafts. The incidence of stress fracture is lower than in massive structural auto-grafts or allografts. Further, the bone union is more rapid, and bone hypertrophy in response to applied stress may occur with time.

 

Since it is in the pediatric age group, the thumb has great importance for hand function, and the lesion is continuous throughout the entire metacarpal bone, we considered reconstruction with a vascularized fibula flap.