Covering the reconstructed area with a healthy soft-tissue envelope is a major challenge after limb-sparing surgery in patients with malignant bone and soft-tissue tumours. Negative pressure wound therapy (NPWT) of open wounds hastens healing and minimises the requirement for complex reconstructive soft-tissue surgery. The aim of this study was to investigate the effectiveness and safety of NPWT in bone and soft-tissue malignant tumour patients with postoperative wound complications. Between January 2006 and November 2009, at a single institution, 13 patients with malignant bone and soft-tissue tumours who had undergone wide resection were retrospectively analysed. NPWT was performed in all patients to temporarily close the soft-tissue defects. After obtaining the culture negativity and normal infection markers, definitive soft-tissue reconstruction was performed to close the wound with primary suturisation in two patients, split thickness grafts in four patients, full thickness grafts in two patients, rotational flaps in three patients and free flaps in two patients. Mean duration of hospitalisation was 20 (range 8-48) days and mean follow-up period was 57·3 (range 50-74) months. There was no tumour recurrence or skip metastasis in the follow-up period. In addition, there was no periprosthetic infection or complication associated with NPWT. In conclusion, NPWT therapy seems to be a safe and effective option in the management of local wound problems and secondary surgical site infections after musculoskeletal tumour surgery.

BackgroundAn unfavorable condition for bone healing is the presence of bone defects. Under such conditions, a material can play a role to cover fractured or defective bone. Technological advances now allow for the use of such material. Hyalonect® (Fidia Advanced Biopolymers SLR, Italy), a novel membrane comprising knitted fibers of esterified hyaluronan (HYAFF11) can be used to cover fractured or grafted bone and can also serve as a scaffold to keep osteoprogenitor cells in place. The aim of this study was to compare osteoblastic activity by the use of scintigraphic methods in defective rabbit tibias during early-phase bone healing with or without a hyaluronan-based mesh.MethodsTwo groups (A and B) of New Zealand albino rabbits were used; each group included 10 animals. Operations on all rabbits were performed under general anesthesia. We also resected 10-mm bone segments from each animal’s tibial diaphysis. After resection, tibias with defects were fixed using Kirschner wires. In group A, no hyaluronan-based mesh was used. In group B, tibial segmental defects were enclosed with a hyaluronan-based mesh. The rabbits were followed up for 4 weeks postoperatively, after which bone scintigraphic studies were performed on each animal to detect and compare osteoblastic activity.ResultsThe mean count in the fracture side of the hyaluronan-based mesh group was significantly higher compared to that of the group A (p = 0.019). However, there was no significant difference between group B and control rabbits with respect to the mean count on the intact bone side (p = 0.437). The bone defect (fracture)/intact bone mean count ratio was significantly higher in group B compared to group A (p = 0.008).ConclusionsA hyaluronan-based mesh plays a role in promoting osteoblastic activity. Hyalonect® is suitable for restoring tissue continuity whenever the periosteal membrane is structurally impaired or inadequate. Our results demonstrated that, during early-phase bone healing, osteoblastic activity was increased in bone defect sites when a hyaluronan-based mesh was also used. The most important aspect of this study concerns its scintigraphy-based design. This study is the first to use a scintigraphic method to demonstrate the effectiveness of hyaluronic acid-based material for bone healing.

Objectives:To compare femoral and tibial tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction using an interference screw (IS), or an EndoButton-Continuous Loop (EndoButton-CL®) on the femoral side, and an IS/staple on the tibial side.Methods:We retrospectively reviewed data on 46 patients who underwent arthroscopic ACL reconstruction with Achilles tendon allografting. Fixation was performed with a bioabsorbable IS (the IS group) in 24 patients (mean age 26.5 years), and with the EndoButton-CL device (the EB group) in 22 patients (mean age 28.1 years) on the femoral side. Evaluation included standardized anteroposterior (AP) and lateral radiography. The diameters of tunnels at the last follow-up visit (at a median time of 17 months postoperatively) were compared to those noted on radiographs taken 1 day postoperatively.Results:The two groups were similar in terms of age and gender distribution, the operated side, the size of the tunnel created, and the follow-up period (p>0.05). Femoral TW at the proximal and middle levels (on both anteroposterior and lateral views) in the IS group was significantly greater than in the EB group (p<0.050 for all comparisons). No significant difference in femoral TW at the distal level was evident between the groups, and tibial TW at all levels was similar in both groups (p>0.050).Conclusion:Femoral ACL graft fixation using an EndoButton-CL reduced femoral TW compared to use of an IS.

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