Non Blood Transfusion Limb Salvage Operation in the Distal Femur Osteosarcoma Patient: A Case Report / 대한골관절종양학회지

Limb salvage operations for osteosarcoma of the extremity usually consist of wide excision and skeletal reconstruction. Most osteosarcoma patients are anemic prior to the surgery as majority of them undergo preoperative neo-adjuvant chemotherapy; thus, it is necessary to treat anemia before and after the surgery since limb salvage operation tends to accompany significant blood loss. Despite the fact that blood transfusion has bad influence on prognosis, complication, and postoperative outcome of cancer patients, it is still considered as a standard management to fix anemia for limb salvage operations. We would like to present a case report in which the authors succeeded in performing limb salvage operations on patients with distal femur osteosarcoma without transfusion.

Evaluation of the Pectoralis Major Myocutaneous Flap for Oral and Maxillofacial Reconstructive Surgery

Soft tissue repairing and functional reconstruction in limb salvage operation on extremity bone malignant tumors / 中南大学学报(医学版)

Objective To investigate the effect and the significance of soft tissue repairing and functional reconstruction in limb salvage operation on extremity malignant bone tumors by individulized prosthesis replacement after malignant tumor resection with the help of Neo-adjuvant chemo-therapy. Methods A total of 78 patients with malignant bone tumor were recruited, including 42 males and 36 females. Aged 19～61, with an average of (29.12±9.47).Tumor in 14 patients was in the proximal humerus, 11 in the proximal femur, 27 in the distal femur, 3 in femoral middle part, and 23 in the proximal tibial. There were 29 cases of osteogenic sarcoma, 18 chondroma sarcomatosum, 7 maligant enchondroma with pathological fracture, 20 maligant giant cell tumor,and 4 maligant inflammatory myofibroblastoma of the bone. Soft tissue repairing and functional reconstruction were carried out together with individualized prosthesis replacement. The type of the prostheses was as follows: 14 patients had long stem humerus head prosthesis, 50 made hinged knee prostheses with femoral or tibial component, 3 whole femur replacements, 7 long stem femoral head prostheses, 4 long stem hip prostheses.Results All patients were followed up for an average of (26.80±8.06) months (4～37 months) and postoperative functions were estimated according to Enneking system. Among the 78 patients, results in 48 (61.5%) were excellent, 17(21.8%) were good,10 (12.8%) were fair,and 3(4.9%) were poor. The satisfactory rate was 83.3%. Conclusion Soft tissue repairing and functional reconstruction in limb salvage operation on extremity bone malignant tumors by individualized prosthesis replacement not only spare the limbs, but also keep their function.It can remove the psychologic obstacles caused by extremity absence, and is effective for bone malignant tumor.

Low-heat Treated Intercalary Autograft Reconstruction in Limb Salvage of Primary Malignant Bone Tumor / 대한정형외과학회잡지

PURPOSE: This study evaluated the effectiveness of a low-heat treated intercalary autograft reconstruction in primary malignant bone tumors mainly involving the diaphysis. MATERIALS AND METHODS: Twenty patients who had primary malignant bone tumors underwent a low-heat treated intercalary autograft reconstruction between May 1987 and May 2004. The mean age was 24 years, and the mean follow up was 59.8 months. Osteosynthesis between host bone and low-heat treated autograft was carried out using plates and screws (n=7), rigid IM nails (n=6), plates and flexible IM nails or K-wires (n=4), and rigid IM nail and plate (n=3). Intramedullary cement augmentation was performed in 10 patients but the primary bone graft on the host-graft junction was not performed. RESULTS: The mean segmental excised bone length was 152 mm. One patient died from acute cardiac arrest unrelated to the tumor but there was no local recurrence and metastasis. Host graft union was achieved in 18 patients after a mean of 8.5 months after surgery. Complications were observed in 7 patients (35%), including 3 fractures, 2 nonunions, and 2 infections. The mean functional outcome was 82% (24.6). CONCLUSION: A low-heat treated intercalary autograft is a simple, economic and best fitting reconstruction system with a low rate of ultimate failure in carefully selected patients. However, a long term study will be needed to evaluate the graft incorporation and possibility of bone resorption.

Diagnosis and treatment of malignant fibrous histiocytoma of bone / 中国矫形外科杂志

[Objective]To approach the clinical characteristic,diagnosis and method of treatment of malignant fibrous histiocytoma of bone.[Method]The clinical data of 52 patients of malignant fibrous histiocytoma of bone were analyzed retrospectively,including sites of tumor,preoperative imageology,puncturing biopsy,surgical staging of tumor,methods of treatment,results of follow-up,and so on.[Result]In all 52 cases of malignant fibrous bistiocytoma of bone,32 cases were in periphery of knee joint,14 cases in periphery of shoulder joint,3 cases in the proximal femur,1 case in calcaneus,1 case in lumbar and 1 case in ilium.The preoperative imageelogy and puncturing biopsy were made as usual.There were 20 cases in staging of ⅡA and 32 cases in in staging of ⅡB according to Ennekings surgical staging of tumor.All cases were performed operation except of 1 case.The operation were made salvage limb mosfly and the ratio of limb salvage was 74.5 %(38/51).The preoperative and postoperative chemotherapy and radiotherapy were performed at the same time.Thirty-six of all cases were in long-time follow-up and the ratio of follow-up was 69.2%(36/52).Nine cases were recurred in the region,6 cases had distant metastasis and survival rate of 5 years was 61.1%(22/36).[Conclusion]Preoperative puncturing biopsy and imageology can help the diagnosis of malignant fibrous histiocytoma of bone.Surgery is the primary method and radiotherapy and chemotherapy can prevent the recurrence of the tumor.The resection of the tumor thorough is the key point of healing of malignant fibrous histiocytoma of bone.

Pathologic Fracture of Primary Malignant Bone Tumor: Survival, Limb Salvage, Local recurrence / 대한정형외과학회잡지

PURPOSE: This study analyzes the indication, survival rate, local recurrence and limb salvage possibility of primary malignant bone tumors that have had pathologic fractures. MATERIALS AND METHODS: Eighteen cases that received preoperative chemotherapy and surgery were eligible for this study. Primary tumors were osteosarcoma (13) , Ewing's sarcoma (2) and MFH (3) . Primary locations were femur (10) , humerus (6) , and tibia (2) . Fractures were classified into three grades. Grade I (10) was mild displacement, II (5) was moderate but intracompartmental, III (3) was extracompartmental. Average follow-up was 40 months. RESULT: Limbs were salvaged in 16 cases, 2 cases had amputation. Union was acquired in 7 (7/10) cases for grade I and 4 (4/6) cases for grade II. Two cases with severe displacement both ended in non-union. There were two local recurrences. The actual survival rate of the 13 cases with osteosarcoma was 33% in 80 months, showing significantly lower results compared to 238 contemporary cases of IIB (P=0.04) . CONCLUSION: Conservative external immobilization and preoperative chemotherapy for pathologic fracture of primary malignant bone tumor was good initially in the care of amputation. Local recurrence rate was 11 percent and survival rate was significantly worse.

Results of Limb Salvage Surgery in Primary Malignant Bone Tumors / 대한정형외과학회잡지

Limb salvage operation in primary malignant bone tumors is increasing recently, according to the improvement of diagnostic methods, surgical technique and adjuvant chemotherapy. The purpose of this study is to obtain the interim results of survival rate and the functional grade of the limb in primary malignant bone tumors treated by limb salvage operation. Between 1985 to 1993, 63 primary malignant bone tumors treated by limb salvage operations. Tumor prosthesis arthroplasty was performed in 49 patients, resection arthrodesis in 9 patients, and IM nailing with cement molding in 5 patients. Autoclave autograft was combined in 2 patients. Adjuvant chemotherapy and postoperative radiotherapy were performed in selected patients. The average follow-up period was 50 months(ranged 12 months to 116 months). In the cases of osteosarcoma, estimated survival rate was 61.9% based on Kaplan-Meier survival plot. In the parosteal sarcoma, the survival rate was 87.5% and 80% in chondrosarcoma patients. According to functional grading by Enneking, 66% was excellent, 20% was good, 11% was fair and one patients was poor. Complications occurred in 16 patients:wound infection was developed in 6 patients, local recurrence in 4, peroneal nerve palsy in 2 patients and femoral stem loosening in 2 patients. Fracture in resection arthrodesis and pulmonary metastasis were also occurred. Reoperation was performed in 10 patients at average 31 months after initial operation. Revision tumor persthesis arthroplasty was performed in one patient due to local recurrence and in 2 patients due to femoral stem loosening. Three amputations were done due to recurrence of tumor. IM nailing with cement molding was performed in one patient due to deep infection and repeated arthrodesis was done in a fracture patients. Scheduled custom-made tumor prosthesis arthroplasty was performed within a year in 2 patients treated with IM nailing with cement molding. In conclusion, with the careful preoperative assessment, adjuvant chemotherapy and skillful surgical technique, limb salvage operation would provide the primary malignant bone tumor patients for longer survival and better quality of life.

Treatment of penile prosthetic infection with removal of the infected prosthesis and simultaneous implantation of a new one / 대한비뇨기과학회지

Penile prosthesis implantation has become an established and a very successful method for treatment of the erectile dysfunction. But complications still occur, and the most devastating is infection. There has been 3 therapeutic options for the infected prosthesis. One is the removal of all components of the prosthesis and the reinsertion of a new prosthesis after 4 months or more. Another one is to remove all parts of the prosthesis, irrigate the wound copiously with antibiotic irrigant and insert a new prosthesis before closure. This latter procedure has been termed a salvage operation. The purpose of the salvage procedure is to maintain penile length and enable easy insertion of the cylinders. But the placement of a foreign body in a potentially infected wound is not a standard surgical procedure. An alternative to immediate salvage of an infected prosthesis is "delayed salvage". We performed a salvage operation in a patient with prosthetic infection. There was a large defect in corpus cavernosum due to the infectious necrosis. So we closed the corpus cavernosum with the aid of Dacron patch. We have a satisfactory result with a follow-up of 12 months.

Treatment of Malignant Bone Tumors by Tumor Prosthesis / 대한정형외과학회잡지

Limb salvage operation was introduced to treat, low grade malignant bone tumors about 100 years ago. However, amputation has been the most popular choice for primary malignant bone tumors. Recent improvement of chemotherapy, diagnostic methods and surgical techniques enabled us to treat more malignant bone tumors such as osteogenic sarcoma with limb salvage operation. 6 cases of malignant bone tumors were treated with wide resection and tumor prosthesis from Oct., 1987 to Jan., 1989 at Dept. of Orthopedic Surgery, Seoul National University Hospital. 4 cases of osteosarcoma, 1 case of parosteal osteosarcoma and 1 case of chondrosarcoma were identified. MRI was useful for determining the extent of tumor and surgical planning. All the patients osteosarcoma had neoadjuvant chemotherapy. The mean follow-up was 14.5 months ranging from 8 to 22 months, and theirresults are so far good except one pulmonary metastasis and one local recurrence. We present this as a preliminary report.

Limb-salvage operations in primary malignant tumors of the bone: interim report

Between June 1985 and March 1990, 25 patients with primary malignant bone tumors, including 15 cases of osteogenic sarcoma, two cases of periosteal osteogenic sarcoma, six cases of chondrosarcoma, and two cases of malignant fibrous histiocytoma, were treated with limb-salvage procedures. Fourteen patients underwent limb salvage operations with tumor prosthesis arthroplasty, 6 with resection-arthrodesis, 4 with wide resection, and 1 with autoclaved autograft. Pre- and/or post-operative chemotherapy with or without radiotherapy was combined with these limb salvage operations. The average follow-up period was 25.2 months (6 to 52 months) since diagnosis. The estimated 3.5-year survival rate of the total 25 patients was 39.5% based on the Kaplan-Meier survival plot. In the 15 cases of osteogenic sarcoma, the estimated Kaplan-Meier 34-month survival rate was 46.2%. Seventeen patients who were followed up for more than 1 year were grouped by functional grading: 11 (65%) were excellent; 3 (18%) good; 2 fair (12%); and 1 poor. Complications occurred in 4 patients, 1 had a local recurrence, 2 had superficial wound infections, and 1 a loosening of the femoral stem. Metastases were shown in 15 case, and the most common location was the lung.