Ewing's sarcoma
Transposition of the radius to the ulna
Ewing’s sarcoma. In 2007, we performed a surgical procedure to treat a primitive bone tumor, diagnosed as Ewing Sarcoma . This form of tumor is known for its aggressiveness and treatment challenges. The surgical intervention involved resection of the ulna, a bone in the forearm, which was affected by the injury.
Before surgery, tests such as bone scintigraphy and resonance were performed to stage the extent of the tumor. The results indicated a single injury to the right ulna. We opted for a surgical approach after the neoadjuvant chemotherapy phase.
The surgery began with meticulous preparation of the patient and the delimitation of the biopsy path to guide the resection, with an oncological margin. The iliac bone was prepared to obtain an autologous graft segment, necessary for wrist reconstruction, after removal of the compromised ulna segment. We use the term cautery (electric scalpel) to dissect tissues with better hemostasis and precision, minimizing damage to surrounding tissues and obtaining a better oncological margin.
After circumferential delimitation of the tumor, we performed resection of the compromised ulna, followed by preparation for the reconstruction by placing the head of the radius, the other bone of the forearm, in the groove between the humeral condyles, suitable to function with flexion-extension, in this new forearm with a single bone. The iliac bone graft segment was then used to promote distal radio-ulnar synostosis, that is, the fusion of the radius and ulna bones, stabilizing the new wrist.
During surgery, suture techniques were used to fix the head of the radius to the tendon of the triceps brachii muscle, to ensure the stability of the new elbow, providing satisfactory flexion-extension. Screw and pin were used to ensure adequate fixation of the distal radio-ulnar synostosis.
After completion of the surgery, an x-ray was performed to evaluate the outcome of the procedure. The tumor was completely resected, and 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’s 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 appropriate technology, we are able to fulfill our commitment to providing the best possible care to patients facing such complex and difficult health challenges.
Prof. Dr. Pedro Péricles Ribeiro Baptista drpprb@gmail.com +55 11 99863-5577