Background: Bone and soft-tissue sarcomas are uncommon, and their
location in the foot is extremely rare. While limb salvage has become the
standard of care in the treatment of sarcoma in an extremity, the unique
anatomy of the foot presents challenges in reconstructing a viable and
Methods: Between 1998 and 2005, we used free microvascularized
osteomyocutaneous fibular grafts to reconstruct the defects created after
extensive midfoot resection in six consecutive patients with a primary
malignant tumor. In all but one patient, the extent of the resection involved
at least two metatarsals. The mean age (and standard deviation) at the time of
the operation was 30 ± 13 years. At the final follow-up examination,
clinical and radiographic evaluations were performed on all patients, and
functional outcome and quality of life were assessed with use of the
Musculoskeletal Tumor Society score, the American Orthopaedic Foot and Ankle
Society Score, and the Toronto Extremity Salvage Score.
Results: The median duration of follow-up was 52.2 months. Limb
salvage was achieved in five patients. In the remaining patient, amputation
was necessary because of flap failure. Revision surgery was necessary in all
patients because of complications (skin ulcerations in three patients;
hematoma in two patients; and infection, necrosis of the second toe, and flap
necrosis in one patient each). At the time of final follow-up, five patients
had satisfactory function and reported good quality of life. The average
Musculoskeletal Tumor Society, American Orthopaedic Foot and Ankle Society,
and Toronto Extremity Salvage scores were 82%, 75 points, and 92%,
respectively. At the time of the final follow-up, five patients had no
evidence of disease and one patient had disease.
Conclusions: Following the resection of a malignant tumor in the
midfoot, the use of microvascularized osteomyocutaneous fibular grafts has
proven to be a successful surgical technique, offering an alternative to
ablative surgery with functional restoration of the salvaged limb.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.