(Jurnal Plastik Rekonstruksi, 2025.
Vol 12.
No 1, 58-.
MICROSURGERY Case Report
A SUCCESSFUL LIMB-SPARING APPROACH IN SYNOVIAL
SARCOMA OF THE FOOT: A CASE REPORT
Sara Ester Triatmoko1,2.
Bob Andinata3.
Parintosa Atmodiwirjo4.
Mohamad Rachadian Ramadan4.
Elida Sari Siburian2.
Andika Prasdipta Hidayat2.
Elisa Jonathan2, & Jesica Putri Sudarman2 Plastic.
Reconstructive, & Aesthetic Surgery Division.
Department of Surgery,Brawijaya Hospital Saharjo.
Jakarta.
Indonesia Plastic.
Reconstructive, & Aesthetic Surgery Division.
Department of Surgery.
Fatmawati Hospital.
Jakarta.
Indonesia.
Oncology Surgery.
Department of Surgery.
Brawijaya Hospital Saharjo.
Jakarta.
Indonesia.
Plastic.
Reconstructive, & Aesthetic Surgery Division.
Department of Surgery.
Cipto Mangunkusumo National Central General Hospital.
Jakarta.
Indonesia.
ABSTRACT
Synovial sarcoma, although rare, is commonly diagnosed in patients under 20 years of age.
This case presents the case of a 21-year-old female with synovial sarcoma affecting the 1st to 3rd metatarsal and tarsal bones.
She underwent extensive tumor resection, followed by fibula free flap.
The fibula was reconstructed into an L-shape to provide structural support.
A bypass was performed because of compromised blood flow to the first digit, but the digit failed.
Skin necrosis occurred after tumor dissection, necessitating a second reconstruction with an anterolateral thigh flap (ALT) after six weeks.
At the years follow-up, the reconstruction was stable, and radiation therapy further improved the outcomes.
The patientAos gait was satisfactory, with special shoes for weight bearing.
This case demonstrates the potential of limb-sparing surgery with free fibula flaps for synovial sarcoma resection, which offers promising functional and psychological benefits.
Key words: Synovial sarcoma.
Free flap.
Microsurgery Sarkoma sinovial, meskipun jarang, umumnya didiagnosis pada pasien di bawah usia 20 tahun.
Kasus ini melaporkan seorang wanita berusia 21 tahun dengan sarkoma sinovial yang mempengaruhi tulang metatarsal ke1 hingga ke-3 serta tulang tarsal.
Pasien menjalani reseksi tumor ekstensif yang diikuti dengan rekonstruksi menggunakan flap fibula bebas.
Fibula direkonstruksi menjadi bentuk L untuk memberikan dukungan struktural.
Prosedur bypass dilakukan karena aliran darah ke jari kaki pertama terganggu, tetapi jari tersebut tidak dapat Nekrosis kulit terjadi setelah diseksi tumor, sehingga diperlukan rekonstruksi kedua dengan flap paha anterolateral (ALT) enam minggu kemudian.
Pada tindak lanjut satu tahun, rekonstruksi tetap stabil, dan terapi radiasi memberikan hasil yang lebih baik.
Pola berjalan pasien memuaskan dengan penggunaan sepatu khusus untuk menopang berat badan.
Kasus ini menunjukkan potensi operasi penyelamatan ekstremitas dengan flap fibula bebas dalam reseksi sarkoma sinovial, yang memberikan manfaat fungsional dan psikologis yang Kata Kunci: Sarkoma sinovial.
Flap bebas.
Bedah mikro Conflicts of Interest Statement:
The author.
listed in this manuscript declare the absence of any conflict of interest on the subject matter or materials discussed.
10% of all soft tissue sarcomas, with 30% of cases diagnosed in individuals under 20 years of age.
The anatomical complexity of the foot and ankle and rarity of these tumors pose significant surgical challenges.
INTRODUCTION
Foot and ankle tumors are rare, comprising only 4-5% of all musculoskeletal tumors, with malignant sarcomas accounting for just 1-2%.
Most cases originate from mesenchymal tissues, including soft tissues and bone sarcomas.
Synovial sarcoma, a rare subtype, represents 5- The primary goal of managing foot and ankle tumors is complete excision with clear margins to minimize recurrence while preserving Received: 19-01-2025.
Revised: 03-02-2025.
Accepted: 05-03-2025 Copyright by Triatmoko, et al.
, .
iC P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
Published by Lingkar Studi Bedah Plastik Foundation.
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A successful limb-sparing approach in synovial sarcoma of the footA Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2025
Historically, amputation has been the standard treatment because of difficulties in compromising foot function.
Advances in imaging, surgical techniques, and reconstructive options have enabled limb-sparing procedures to offer improved functional and psychological However, inconsistent results from studies on limb salvage, including higher recurrence rates and complications in some cases.
An arterial bypass was performed using the peroneal artery and vein to supply the 1st digit.
Amputation remains associated with significant physical and psychological burden, including depression, altered gait, and increased suicide risk.
Limb-sparing techniques, facilitated by advancements in microsurgery and flap reconstruction, can provide comparable or superior oncologic and functional outcomes, making them preferable options when feasible.
This case study explored the benefits and challenges of limb-sparing surgery in managing foot synovial sarcoma while adhering to oncologic principles.
Figure 2.
Postoperative x-rays, anteroposterior and lateral view of patientAos left foot.
CASE REPORT
A 21-year-old female presented with a 12 y 8 y 7-cm mass on the left foot, suspected to be a synovial sarcoma.
Initially planned for belowknee amputation, the decision was made after consultation to proceed with extended local tumor excision.
Radical resection involved the 1st to 3rd metatarsals and portions of the tarsal bones, guided by frozen sections, to ensure Pathology confirmed synovial sarcoma with a white-grayish myxoid mass with calcifications.
Figure 1.
Preoperative evaluation.
A: The lateral view of the patient's left foot x-rays.
B: clinical condition of patientAos left foot.
Reconstruction of the complex mid-toforefoot defect was performed using an osteocutaneous free fibular flap , with 18 cm of the fibula harvested and split into L-shaped Figure 3.
Postoperative evaluation.
clinical condition of patientAos left foot .
Despite the initial recovery, the deep branch of the anterior tibial artery to the 1st digit was compromised on day 10, leading to hallux ischemia and necrosis, necessitating amputation.
Six weeks post-surgery, an anterolateral thigh (ALT) free flap was used to cover the dorsal defect, and the patient completed radiotherapy.
At six months, the fibula showed stable positioning and some bone fusion, enabling the patient to walk without difficulty.
After 2 years, the skin flap and bone remained intact despite radiation therapy.
Although the plantar surface lacked an arch, the patientAos gait was satisfactory with occasional discomfort during prolonged Copyright by Triatmoko, et al.
, .
P-ISSN 2089-6492.
E-ISSN 2089-9734 iC DOI: 10.
14228/jprjournal.
This work is licensed under a Creative Commons License Attribution-Noncommercial No Derivative 4.
Jurnal Plastik Rekonstruksi.
Vol.
No.
1, 2025
Triatmoko, et al.
, .
A revision to thin the fibula and the ALT flap was planned.
significant emotional trauma, leading to higher risks of depression, demoralization, and even Conversely, limb-sparing approaches offer better psychological outcomes and preserve the patient's quality of life and self-image.
However, the associated health-related costs, spanning multiple reconstructive surgeries, rehabilitation, and prosthetic needs, can impose financial burdens on patients and their families.
Transparent discussions about expectations and potential outcomes are essential to aligning treatment goals with patient preferences and Figure 4.
Postoperative evaluation after 2 years.
DISCUSSION