Limb Salvage Surgery in Bone Tumors: A Retrospective Study of 50 Cases in a Single Center

Chauhan, Ashutosh; Joshi, GR; Chopra, Bhavna; Ganguly, Manomoy; Reddy, Guru

doi:10.1007/s13193-013-0229-8

Cited by 18 publications

(15 citation statements)

References 25 publications

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“…Incidence of massive bone reconstructions has increased in the last years, as limb salvage has become the standard of treatment for patients with high‐energy traumas, malignant bone tumors and osteomyelitis (Azzam & Atef, 2016; Muscolo, Ayerza, Aponte‐Tinao, Ranalletta, & Abalo, 2004). Today, 90% of extremity osteogenic sarcomas can be treated with limb salvage surgery (Chauhan, Joshi, Chopra, Ganguly, & Reddy, 2013). Open tibia fractures occur with an annual incidence of 3.4 per 100,000 (Larsen et al, 2015), and are highly prone to develop fracture related infection, with associated chronic osteomyelitis reported in 5–50% of the patients (Singh, Rambani, Hashim, Raman, & Sharma, 2012).…”

Section: Introductionmentioning

confidence: 99%

Effect of vascularized periosteum on revitalization of massive bone isografts: An experimental study in a rabbit model

et al. 2020

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Introduction In the last years, limb salvage has become the gold standard treatment over amputation. Today, 90% of extremity osteogenic sarcomas can be treated with limb salvage surgery. However, these reconstructions are not exempt from complications. Massive allografts have been associated to high risk of nonunion (12–57%), fracture (7–30%) and infection (5–21%). Association of vascularized periosteum flap to a massive bone allograft (MBA) has shown to halve the average time of allograft union in clinical series, even compared to vascularized fibular flap. Creeping substitution process has been reported in massive allograft when periosteum flap was associated. However, we have little data about whether it results into allograft revitalization. We hypothesize that the association of a periosteum flap to a bone isograft promotes isograft revitalization, defined as the colonization of the devitalized bone by new‐form vessels and viable osteocytes, turning it vital. Materials and Methods Forty‐four New Zealand white male rabbits underwent a 10 mm segmental radial bone defect. In 24 rabbits the bone excision included the periosteum (controls); in 20 rabbits (periosteum group) bone excision was performed carefully detaching periosteum in order to preserve it. Cryopreserved bone isograft from another rabbit was trimmed and placed to the defect gap and was fixed with a retrograde intramedullar 0.6 mm Kirschner wire. Rabbits were randomized and distributed in 3 subgroups depending on the follow‐up (control group: 5 rabbits in 5‐week follow up group, 8 rabbits in 10‐week follow‐up group, 7 rabbits in 20‐week follow‐up group; periosteum group: 5 rabbits in 5‐week follow up group, 7 rabbits in 10‐week follow‐up group, 7 rabbits in 20‐week follow‐up group). Fluoroscopic images of rabbit forelimb were taken after sacrifice to address union. Each specimen was blindly evaluated in optical microscope (magnification, ×4) after hematoxylin and eosin staining to qualitative record: presence of new vessels and osteocytes in bone graft lacunae (yes/no) to address revitalization, presence of callus (yes/no) and woven bone and cartilage tissue area (mm2) to address remodeling (osteoclast resorption of old bone and substitution by osteoblastic new bone formation). Results No isograft revitalization occurred in any group, but it was observed bone graft resorption and substitution by new‐formed bone in periosteum group. This phenomenon was accelerated in 5‐week periosteum group (control group: 49.5 ± 9.6 mm2 vs. periosteum group: 34.9 ± 10.4 mm2; p = .07). Remodeled lamellar bone was observed in both 20‐week groups (control group: 6.1 ± 6.3 mm2 vs. periosteum group: 5.8 ± 3.0 mm2, p = .67). Periosteum group showed complete integration and graft substitution, whereas devitalized osteons were still observed in 20‐week controls. All periosteum group samples showed radiographic union through a bone callus, whereas controls showed nonunion in eight specimens (Union rate: control group 60% vs. periosteum group 100%, p = .003). Conclus...

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Section: Introductionmentioning

confidence: 99%

Effect of vascularized periosteum on revitalization of massive bone isografts: An experimental study in a rabbit model

et al. 2020

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“…High recurrence and metastization rates present in high grade chondrosarcomas, even when margins are adequate, since the grade is the single most important predictor [13,14]. Surgical management of large bone tumors should focus on complete resection and functional preservation of the limb.…”

Section: Open Access Journal Of Surgery Discussionmentioning

confidence: 99%

Total Humeral Replacement with Biarticular Prosthesis after Chondrosarcoma Wide Excision Functional Aspects of Limb Preservation

Serrano¹

2018

OAJS

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Case: A massive proximal humerus high grade chondrosarcoma was diagnosed in a 33-year-old male patient. Diagnosis was confirmed by biopsy and staging was negative. To achieve wide resection and acquire a safe resected margin, total humerus replacement was performed, and the whole humerus was reconstructed. The patient resumed normal activities, with average functional outcome and is very satisfied with the aesthetic result and possibility of limb preservation. Conclusion:Total humeral replacement is an option for preservation of the limb and allows for very good function of the elbow and full function of the hand. Amputation would not guarantee greater survival.

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“…To our knowledge, it appears to be feasible in 90% of cases. The psychological factor of limb amputation still represents a hardly manageable subject [3].…”

Section: Introductionmentioning

confidence: 99%

Multimodal analgesia in primary bone tumors

Bratu

Cursaru

Comanelea

et al. 2021

Romanian Journal of Orthopaedic Surgery and Traumatology

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Introduction: A worrying increase in the number of bone tumors that appear at younger ages justifies the efforts aimed at optimizing perioperative management practices in orthopedic tumor surgery. Pain control is critical in the prognosis and postoperative outcome of these procedures. Material and methods: Our study included a group of 11 patients diagnosed with bone malignancies. These patients were hospitalized in the Orthopedic Clinic of the University Emergency Hospital Bucharest. Under our supervision, they underwent surgical treatment of the tumor under combined general anesthesia and epidural anesthesia for the pelvic limb, and general anesthesia only for the upper limb. We performed perioperative pain management with multimodal analgesia (continuous epidural analgesia with ropivacaine 0,2% and fentanyl 2 mcg/ml in association with systemic analgesics). Following this procedure, we measured the intensity of the postoperative pain at intervals of 48 hours and one week after surgery and compared with preoperative pain intensity using the visual analogue pain scale (VAS). Results: Multimodal analgesia (epidural analgesia associated with systemic analgesics – paracetamol, COX2 inhibitor, gabapentinoids) was performed well in the postoperative pain of the tumor prosthesis, with a significant decrease in VAS from a mean value of 7.63 preoperatively to an average of 3 in the first 48 hours postoperatively. After the removal of the epidural catheter, which also coincided with patient mobilization, the level of pain registered a slight increase to a mean value of 3.23. Conclusions: Multimodal analgesia is currently considered the gold standard in perioperative pain management. The use of multimodal analgesia during perioperative period in patients with bone tumors has been shown to decrease the length of hospital stay, improve surgical outcome, reduce the number of systemic complications, and improve the long-term prognosis of the patient. Efficacy of analgesia correlates with tumor site and vascularization.

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Limb Salvage Surgery in Bone Tumors: A Retrospective Study of 50 Cases in a Single Center

Cited by 18 publications

References 25 publications

Effect of vascularized periosteum on revitalization of massive bone isografts: An experimental study in a rabbit model

Effect of vascularized periosteum on revitalization of massive bone isografts: An experimental study in a rabbit model

Total Humeral Replacement with Biarticular Prosthesis after Chondrosarcoma Wide Excision Functional Aspects of Limb Preservation

Multimodal analgesia in primary bone tumors

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