Proximal humerus is one of the anatomical sites that are most frequently involved by bone and soft tissue malignant tumors. Alone or in association with adjuvant treatments, surgery represents the main therapeutic option to treat and eradicate these diseases. Once the first-line option, in the last decades, amputation lost its role as treatment of choice for the large majority of cases in favor of the modern limb sparing surgery that promises to preserve anatomy and—as much as possible—upper limb functionality. Currently, the main approaches used to replace proximal humerus after a wide resection in oncologic surgery can be summarized in biological reconstructions (allografts and autografts), prosthetic reconstructions (anatomic endoprostheses, total reverse shoulder prostheses), and graft-prosthetic composite reconstructions. The purpose of this overview is to present nowadays surgical options for proximal humerus reconstruction in oncological patients, with their respective advantages and disadvantages.
Introduction: The extensor apparatus of the knee can be thought of a chain that transmits the muscular strength developed by the quadriceps muscles to the proximal tibia. This complex is essential to allow the extension of the tibia over the femur, being essential to provide knee mobility and stability. In case of lesions which irreparably damage the patella, such as a locally aggressive bone tumor, it is necessary to restore both the apparatus’ anatomical continuity and its strength. Case Report: A 67-years-old Caucasian woman developed atraumatic swelling and soreness in her left knee. X-rays and MRI images evidenced an osteolytic degeneration of the patella. A diagnosis of Gigant cell tumor of bone was made with a needle biopsy. We performed an en bloc resection of the patella and replaced it with a composite augment made with a polypropylene mesh and a fascia lata allograft. No complication was observed. In her latest follow-up, our patient did not have any extension lag and quadriceps strength was completely restored. Conclusion: The combination of internal layers of polypropylene surgical mesh and a surface allogenic graft can provide good mechanical performances for patients who underwent patellectomy due to a locally aggressive tumor.
Background
Synovial sarcoma is a rare malignant tumor that generally requires a multidisciplinary therapeutic approach. In this study we report the experience of a single surgeon, evaluating surgical and oncological outcomes of the cases he treated through his 30 years carrier.
Methods
We enrolled patients treated surgically between 1988 and 2018. Surgical and medical treatments, as well as surgical and oncological results, were investigated.
Results
One hundred and thirty cases were included. Surgical resection was carried out achieving wide margins in 90% of the cases. At their latest follow‐up, 76 patients were continuously disease free, 16 were no evidence of disease, and other 16 were alive with disease. Twenty cases were dead of disease and two dead of other causes. Twenty‐five patients (19%) had local recurrence of synovial sarcoma through their postoperative intercourse. Thirty‐seven patients (28%) were diagnosed with at least a metastasis during their follow‐up. The global survival of our population, at each patient's latest follow‐up, was 82%. Cases with tumor size above 5 cm had a significantly higher risk to develop metastasis (p = 0.002).
Conclusions
Synovial sarcoma is a threatening disease and represents a challenge for oncological physicians and surgeons. Early diagnosis and multidisciplinary approach are mandatory to limit the spread of synovial sarcomas, maximizing the effectiveness of surgery and the other treatments.
This report presents the authors’ experience with surgical wound-healing using a negative-pressure wound therapy (NPWT) device in a population of oncological orthopedic patients.
Two groups of 26 oncological patients each underwent surgical excision. After surgery, the control group received standard dressings and the closed incisional NPWT (ciNPWT) group was treated with a ciNPWT system on the sutured wound area for 14 days.
As a primary endpoint, the percentage of post-surgery wound-site complications using ciNPWT devices was compared to that with standard patch dressings. Overall, 30.7% of the control group and 7.7% of the ciNPWT group manifested wound-site complications within 2 weeks after surgery. As a secondary endpoint, final wound healing was compared between the groups: delayed wound healing was observed in 4 (15.4%) patients in the control group and in none (0%) of those in the ciNPWT group. Finally, the length of stay (LOS) was 6.3 days in the control group and 5.1 days in the ciNPWT group.
These results suggest that the ciNPWT device could be beneficial in minimizing the incidence of short-term surgical-site complications and decreasing length of stay in high-risk patients, such as those undergoing oncological orthopedic surgery.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.