Ewing Sarcoma. In 2007, we performed a surgical procedure to treat a primary bone tumor, diagnosed as Ewing Sarcoma.This type of tumor is known for its aggressiveness and challenges in treatment. The surgical intervention involved the resection of the ulna, a forearm bone, which was affected by the lesion.

Before the surgery, exams such as bone scintigraphy and MRI were performed to stage the extent of the tumor. The results indicated a single lesion in the right ulna. We opted for a surgical approach after the neoadjuvant chemotherapy phase.

The surgery began with meticulous patient preparation and the delineation of the biopsy path to guide the resection, with an oncologic margin. The iliac bone was prepared to obtain a segment of autologous graft, necessary for the reconstruction of the wrist, after the removal of the compromised ulna segment. We used electrocautery (electric scalpel) to dissect tissues with better hemostasis and precision, minimizing damage to surrounding tissues and obtaining a better oncologic margin.

After the circumferential delineation of the tumor, we performed the resection of the compromised ulna, followed by preparation for reconstruction with the placement of the radial head, the other forearm bone, in the groove between the humeral condyles, suitable to function with flexion-extension, in this new single-bone forearm. The segment of iliac bone graft was then used to promote distal radioulnar synostosis, that is, the fusion of the radius and ulna bones, stabilizing the new wrist.

During the surgery, suturing techniques were employed to fix the radial head to the triceps brachii muscle tendon, to ensure the stability of the new elbow, providing satisfactory flexion-extension. Screw and pin were used to ensure the proper fixation of the distal radioulnar synostosis.

After the completion of the surgery, an X-ray was taken to evaluate the outcome of the procedure. The tumor was completely resected, and the bone reconstruction was successful. The patient was advised on postoperative care, including physical therapy to promote functional recovery of the affected limb.

The surgery was an important milestone in the patient’s journey against Ewing Sarcoma, representing a significant step in the treatment of this complex disease and providing good function of the operated limb.

Through a multidisciplinary approach and adequate technology, we were able to fulfill our commitment to providing the best possible care to patients facing such complex and difficult health challenges.