Limb-salvage operation for synovial sarcoma of the foot

Abstract 

A 17-year-old male suffered from a continuously increasing size and painless mass on his left medial dorsal foot for many years. The result of a needle biopsy with ultrasound guidance was a high grade synovial sarcoma. The tumour staging was AJCC stages IIC or Enneking stage IIA. Tenodesis of the anterior tibialis tendon to the navicular bone was performed in order to maintain the extensor mechanism of ankle and internal fixation of tarso-metatarsal and midtarsal joints with multiple pins to avoid instability of the midfoot and hind foot. A radial forearm free fasciocutaneous flap was harvested about 10cm×8cm in size and covered the massive soft tissue defect by microsurgery. Dorsiflexion function of the ankle was reconstructed and preserved by the anterior tibials tenodesis to the medial aspect of the navicular bone. Lesser toes extension function was preserved by sparing excision of the extensor digitorum longus tendons but the peritendon was excised. The extensor hallux longus and brevis tendons are widely resected with the residual tendon stumps sutured to the fasciocutaneous flap due to the more medial location of the tumour in this patient. He received six courses of chemotherapy. Local radiotherapy was performed 33 times. There was no recurrence or distant metastasis during a follow-up period of 42 months. The most common treatment for this type of cancer in the dorsal foot is below-knee amputation. If the patient or the patient's family refuse amputation treatment, limb-salvage operation with microsurgical free fascioutaneous flap reconstruction can be considered.

Keywords: Synovial sarcoma, Limb-salvage operation