An intercalary reconstruction is defined as replacement of the diaphyseal portion of a long bone after segmental skeletal resection (diaphysectomy). Intercalary reconstructions typically result in superior function compared to other limb-sparing procedures as the patient's native joints above and below the reconstruction are left undisturbed. The most popular reconstructive options after segmental resection of a bone sarcoma include allografts, vascularized fibula graft, combined allograft and vascularized fibula, segmental endoprostheses, extracorporeal devitalized autograft, and segmental transport using the principles of distraction osteogenesis. This article aims to review the indications, techniques, limitations, pros and cons, and complications of the aforementioned methods of intercalary bone tumor resections and reconstructions in the context of the ever-growing, brave new field of limb-salvage surgery.

Tumors of the hand comprise a vast array of lesions involving skin, soft tissue and bone. The majority of tumors in the hand are benign. Malignant tumors, although rare, do occur and frequently have unique characteristics in this specific anatomic location. Careful staging, histological diagnosis and treatment are essential to optimize clinical outcome. However, straightforward most of the time, hand tumor management does have pitfalls; caution is advised, as a missed or delayed diagnosis or an improperly executed biopsy may have devastating consequences. This article reviews the clinical spectrum of the most common benign and malignant bone and soft tissue tumors of the hand and discusses the clinicopathological findings, imaging features and current concepts in treatment for these tumors.

Atypical lipomatous tumors/well-differentiated liposarcomas are low-grade malignant mesenchymal neoplasms with high propensity to local recurrence and potential to dedifferentiate to higher grades over time. However, the published risks of local recurrence and dedifferentiation vary, and no unified treatment and follow-up plan has been accepted. We performed a study to evaluate the long-term clinical behavior and proper treatment and follow-up strategy for these tumors. We retrospectively reviewed the files of 101 patients treated between 1990 and 2008 with the diagnosis of atypical lipomatous tumors/well-differentiated liposarcomas. For 67 of these patients, complete data and 2-year minimum follow-up were available and were included in the study; 47 patients (group A) had primary surgical treatment at our institution and 20 patients (group B) were referred after ≥1 local recurrences. Mean follow-up was 81 months (range, 24-229 months). The local recurrence rate of primary atypical lipomatous tumors/well-differentiated liposarcomas was 10.6% (5/47 group A patients). The local re-recurrence rate of the recurrent atypical lipomatous tumors/well-differentiated liposarcomas was 52% (13/67 group A and B patients). Recurrences developed as late as 140 months after diagnosis and treatment. The rate of dedifferentiation at recurrences was 4% (1/25 group A and B patients with recurrent tumors). No patients developed metastases. Atypical lipomatous tumors/well-differentiated liposarcomas are associated with an increased rate of local re-recurrence and low risk of dedifferentiation at recurrences. Long-term follow-up is recommended for early diagnosis and treatment of local recurrences.

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.

Surgical management of primary musculoskeletal tumors of the shoulder girdle is cognitively and technically demanding. Over the last decades, advances in the medical treatments, imaging and surgical techniques have fostered limb salvage surgery and reduced the need for amputation. Despite well-accepted general principles, an individualized approach is often necessary to accommodate tumor extension, anatomical challenges and patient characteristics. A combination of techniques is often required to achieve optimal oncologic and durable functional outcome. Goal of this article is to review approach and management of patients with locally advanced sarcomas of the shoulder girdle requiring major tumor surgery, to illustrate principles of surgical strategy, outcome and complications, and to provide useful guidelines for the treating physicians.