Perioperative irradiation in extremity soft tissue sarcoma

Mahmoud, Omar; Wolfson, Aaron H.

doi:10.1586/era.11.95

Cited by 5 publications

(1 citation statement)

References 82 publications

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“…In humans, some bone sarcomas, most commonly Ewing sarcoma, adjuvant radiotherapy is a treatment option, being reported adverse effects of radiation therapy on up to 74% of patients [76][77][78], namely wound healing problems, infection, muscle and joint contracture, ankylosis, osteitis, non-union, pathological fractures, tendon adhesion, and radiation induced sarcoma [76][77][78][79]. In a rabbit tibia model, it was demonstrated that radiation exposure decreases the quantity and quality of regenerate and angiogenesis during a DO [80].…”

Section: Distraction Osteogenesis After Oncologic Surgerymentioning

confidence: 99%

Distraction Osteogenesis: Biological Principles and Its Application in Companion Animals

Domingos¹,

Armés²,

Dias³

et al. 2021

Clinical Implementation of Bone Regeneration and Maintenance

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Distraction osteogenesis is a surgical technique widely used in orthopedic surgery for treatment of various pathological skeletal conditions, namely correction of limb-length discrepancies, angular deformity and treatment of distal and severely comminuted fractures, or bone defects through bone transport. The basic principle consists on the gradual distraction of two bone segments, previously submitted to a corticotomy and promptly fixated generally using of circular external skeletal fixation. New bone tissue is generated in the bone gap between the two segments. This review aims to describe the biological fundaments and principles of this technique, the surgical steps performed to attempt distraction osteogenesis, and its possible complications with main focus on its application in companion animals.Bone Grafts 2 latency period will be applied, and (iv) the distraction rate (DR) must be appropriate for the level and type of bone in which osteogenesis is being performed [5].After the separation of both segments, three temporal phases of DO can be defined: latency period, distraction period, and consolidation period [3]. Osteotomy and corticotomyThe DO procedure begins with the transverse section at a diaphyseal or metaphyseal level of the long bone to be elongated. Ilizarov described three methods to create fractures, including osteotomy, corticotomy, and osteoclasis. The osteogenic potential of the osteotomy or corticotomy depends on three main factors: the localization in bone, the type of technique used, and the latency period subsequently applied [6, 7].Regarding the localization, some researchers in the past referred that the bone lengthening should be performed in the middle of the diaphysis of the long bone, and when necessary elongation was obtained, a bone graft from the ilium crest could be applied on the distraction focus to promote its consolidation. Later, Ilizarov recognized the metaphysis as the ideal site for the osteotomy, due to its massive trabecular bone area, rich in collateral vascularization, and higher potential for fracture recovery. Other researchers compared the regenerated bone quality at the diaphysis and metaphysis after DO, while using different latency periods. In the metaphysis, latency periods of 0 and 7 days allowed a greater osteogenesis and a faster remodeling and consolidation, when compared to the diaphysis elongation. A latency period of 14-21 days was associated with a premature consolidation in both regions. Bone mineralization of the newly formed tissue was faster at the metaphysis than at the diaphysis. Curiously, when there was no latency period, the distraction was successful and the consolidation faster. The latency of 7 days did not reveal the risk of premature consolidation; however, the consolidation and bone formation were slower than where there was no latency period. Post mortem torsion and bending test revealed that the bone tissue elongated on the metaphysis was tougher and more resistant. Histologically, the osteogenesis is observed to be based on intra-mem...

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Section: Distraction Osteogenesis After Oncologic Surgerymentioning

confidence: 99%

Distraction Osteogenesis: Biological Principles and Its Application in Companion Animals

Domingos¹,

Armés²,

Dias³

et al. 2021

Clinical Implementation of Bone Regeneration and Maintenance

View full text Add to dashboard Cite

show abstract

Distraction osteogenesis reconstruction of large segmental bone defects after primary tumor resection: pitfalls and benefits

Lesenský

Prince

2017

Eur J Orthop Surg Traumatol

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Successful cure is achieved in almost 70% of patients with primary bone sarcomas with currently available therapies. Some soft tissue sarcomas require wide bone resection in order to achieve appropriate margins for cure of disease, and patients undergoing these procedures need durable reconstruction. Biological reconstruction has been shown to provide patients with superior long-term results over other alternatives. Distraction osteogenesis is well studied in the correction of deformities as well as in addressing some congenital musculoskeletal pathologies. The use of this technique in tumor settings has been avoided by many surgeons for a multitude of concerns, including infection risk, potential tumor activation, and uncertainty regarding the effect of systemic therapy on the callus regenerate. We review the use of this reconstruction technique using cases from our institutional experience to illustrate its incorporation into the successful management of orthopedic oncology patients. Distraction osteogenesis is an effective method for reconstructing even large bony defects and is safe in the setting of systemic therapy. This technique has the potential to address some of the common problems associated with orthopedic oncology resection, such as infection and leg length discrepancy.

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The use of distraction osteogenesis for reconstruction of bone defects after tumor resection of high-grade lesions

Prince¹

2013

Current Orthopaedic Practice

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Perioperative irradiation in extremity soft tissue sarcoma

Cited by 5 publications

References 82 publications

Distraction Osteogenesis: Biological Principles and Its Application in Companion Animals

Distraction Osteogenesis: Biological Principles and Its Application in Companion Animals

Distraction osteogenesis reconstruction of large segmental bone defects after primary tumor resection: pitfalls and benefits

The use of distraction osteogenesis for reconstruction of bone defects after tumor resection of high-grade lesions

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