• Rua General Jardim, 846 cj 41 Higienópolis, São Paulo - SP

This digital library houses the book on Oncology and Orthopedic Oncosurgery.

It includes academic lectures, presentations from national and international congresses, published papers, case discussions, performed surgical procedures, and proprietary techniques developed.

The digital format was chosen because the web allows the inclusion of texts with numerous visual resources, such as images and videos, which would not be possible in a printed book.

The content is intended for students, healthcare professionals, and the general public interested in the field.

Biological Bone Reconstructions part I

Biological Bone Reconstruction part I

Figure 1: A 5-year-old female patient diagnosed with Ewing's sarcoma in the meta-diaphyseal region of the left humerus. After preoperative chemotherapy, we performed a proximal and distal trans-epiphyseal osteotomy in the middle third of the humerus diaphysis, resecting the lesion. The reconstruction was performed with an autologous fibula graft, complemented by an iliac graft, and fixed with a special plate made to measure for the patient, resulting in a detailed reconstruction, as shown on the post-operative radiograph
Figure 2: Left shoulder function with good elevation two months after surgery, with progressive improvement over three years and ten months, including gain in external rotation.
Figure 3: In adolescence, we detected a shortening of the humerus due to the resection of the epiphyseal plate, performed as an oncological safety margin.
Figure 4: Adolescent with good function and aesthetics. The fibula usually regenerates in children. We can see a slight alteration in the iliac graft donor area, with the radiograph revealing its good integration

Video 1: Excellent function 24 years after surgery, with good elevation of the operated limb and good internal and external rotation.

Figure 5: Now pregnant and cured of the disease, in 2022 she completed 31 years of treatment, happy, hugging her son
Figure 6: Microsurgery and extensible internal fixation used in this child with osteosarcoma in the metaphysis of the humerus. After neoadjuvant chemotherapy, we resected the lesion through a proximal trans-epiphyseal incision, preserving the joint. In detail, the ligation of the tumor's nutricial artery. The diagram on the right illustrates the fixation of the epiphysis by a special blade plate, custom-made for this case, coupled to the extensible internal fixation device, stabilizing the deviation forces and, at the same time, allowing proximal displacement of the epiphysis.
Figure 7: In this case, we positioned a screw below the stem to prevent distal slippage. The image shows the plate and device designed specifically for this patient. The surgery continues with the release of the pectoral muscle tendon.

Video 2: The placement of the osteosynthesis and the positioning of the device took place before the microsurgery, allowing detailed observation of its sliding mechanism. We detail the positioning of the device in the reconstruction.

Video 3: In this film, we can see the broad mobility of the shoulder, with excellent external and internal rotation, as well as the good stability of this set-up.

Figure 8: So, we performed an autotransplant of growth cartilage from the fibula to the humerus, using a special lamina plate and a device that will allow the lamina plate to be displaced, allowing growth proximally. We then placed the distal locking screw to protect against compressive forces. In detail, the surgery finished with microsurgery, in this autotransplant of the fibula, with its proximal epiphyseal plate, guaranteeing the maintenance of limb growth. Motor function of shoulder elevation with good external rotation mobility.
Figure 9: In this way, this osteosarcoma of the humerus was operated on and reconstructed with a dynamic fixation of an autologous, vascularized fibula, transplanted by microsurgery, together with its epiphyseal growth plate. An autologous growth cartilage transplant.
Figure 10: Giant cell tumor of the radius, with great inflation and local aggressiveness. The MRI study shows that the lesion does not invade the soft tissues, but only displaces the tendons. This allowed for oncological resection of the tumor, which was operated on using a wide dorsal incision, starting at the apophysis of the ulna, moving towards the styloid of the radius and curving proximally. We opened the wrist joint, released the tendons from their pulleys and removed the tumor.

Video 4: Video showing dynamic osteosynthesis

Video 5: Video showing the patient’s post-operative motor function

Figure 11: The pronator quadratus muscle is removed along with the lesion, allowing an oncological approach to the tumor. For the reconstruction, we use the proximal segment of the ipsilateral fibula, which is carefully removed from its bed. In detail, arrow number 1 indicates the long tendon of the biceps muscle, arrow 2 points to the tibialis anterior muscle, arrow 3 highlights the flexor digitorum longus muscle and arrow 4, which is red, transparently highlights the external popliteal sciatic nerve. The head of the fibula must be resected, preserving all of its joint capsule, circumferentially, so that a perfect and stable joint reconstruction of the wrist can be carried out, preventing subluxation. Obtaining this graft is often more time-consuming and laborious than removing the tumor from the wrist.
Figure 12: After a few weeks, wrist muscle strength is symmetrical, as is wrist pronation-supination mobility and finger flexion, which show normal and balanced functioning.

Vídeo 6

Vídeo 7

Figure 13: Free dorsal flexion, with good wrist stability. Excellent prono-supination, freedom of movement, ease and symmetry. Palmar flexion limited to 45 degrees. Excellent rotational performance of the wrist, with ample normal flexion-extension of the hand and fingers, whose tendons had all been released.

Video 8: Firm, strong and symmetrical grip of the wrists,

Video 9: A lot of courage, strength and daring, completing 15 years of surgery in 2015.

Figure 14: Biological reconstruction of the radius with an autologous free fibula graft, without the need for microsurgery. Dorsal flexion of the wrist is normal, while palmar flexion is slightly limited.

Video 10: 23 years after the surgery, the patient shows ample mobility of the operated wrist.

Case Author

Author: Prof. Dr. Pedro Péricles Ribeiro Baptista

 Orthopedic Oncosurgery at the Dr. Arnaldo Vieira de Carvalho Cancer Institute

Office :  Rua General Jardim, 846 – Cj 41 – Cep: 01223-010 Higienópolis São Paulo – SP

Phone: +55 11 3231-4638  Cell:+55  11 99863-5577   Email:  drpprb@gmail.com

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