Extraskeletal Ewing sarcoma (EES) is a relatively uncommon primary tumor of the soft tissues, which accounts for 20-30% of all reported cases of ES. Being uncommon, all members of the ES family tumors are treated following the same general protocol of sarcoma tumors. The present review summarizes the diagnosis, management and prognosis of EES, focusing on the differences between the subtypes of ESS. The clinical features and imaging of EES are also discussed. Magnetic resonance imaging is the modality of choice for diagnostic imaging and local staging, while core-needle biopsy with pathological testing is used to obtain a definitive diagnosis. Although several oncology groups endorse that ES family of tumors should be treated with similar algorithm and protocols, some studies have demonstrated that surgery and radiotherapy may be used as a form of local control. However, further studies are required to conclude the optimum treatment option for EES. Contents 1. Introduction 2. Epidemiology 3. Diagnosis 4. Treatment 5. Prognosis 6. Conclusions

The efficacy of free composite tissue transfer for the treatment of chronic osteomyelitis of the leg and foot was evaluated in a retrospective study. Twenty-two patients, operated on at the American University of Beirut between January, 1992 and December, 1996, were identified. Infection involved the heel (8), ankle (1), foot (5), and tibia (8). All patients had multiple debridement and prolonged antibiotic treatment prior to presentation. The mean duration of disease was 4.8 years (range: 1 to 25 years). There were five cases of infected tibial non-union and one case of an infected tibial bone defect measuring 15 cm. Following radical debridement, microvascular free-tissue transfer was immediately performed. One latissimus dorsi and 13 rectus abdominis muscle flaps, as well as eight radial forearm fasciocutaneous flaps were used. At a mean follow-up of 3.8 years, there was one rectus abdominis free-flap failure in a Gustilo IIIC tibial fracture, which necessitated secondary amputation; there was no evidence of recurrence of osteomyelitis in the remaining 21 patients during the study period. The patients with tibial nonunion and bone defect healed following resection and bone transport utilizing a callus distraction technique. The results show that free-tissue transfer is a safe and viable treatment option in chronic osteomyelitis of the leg and foot. A brief discussion of the history of microvascular free-tissue transfers, as well as their value in modern reconstructive surgery, is also presented.

Background Results of the use of the non‐invasive expandable endoprosthetic device Repiphysis® in limb salvage surgery for skeletally immature children with bone cancer have been promising. Procedure In this report, we analyze the outcomes and complications associated with using 17 Repiphysis® prosthesis from January 2002 to March 2009 in 17 skeletally immature children with bone sarcoma around the knee. Results The average follow‐up was 61.7 months. All patients who underwent active expansion experienced successful lengthening with a total of 38 lengthening sessions and an average of 8.6 mm gained per session. The Musculoskeletal Tumor Society functional scores averaged 90% at the most recent follow‐up. The average survival time of the device from implementation to revision or last follow‐up was 2 years and 8 months. There were 12 complications in 12 patients, including 6 mechanical problems, 2 tibial fractures and 3 infections. For the 17 insertions, 7 revision operations were performed, 3 of which were done using a new Repiphysis® device. Conclusions Despite the high rate of complications, the goal of achieving equal leg length at skeletal maturity with fewer surgeries per patient has been relatively achieved with the use of this device. Pediatr Blood Cancer. 2010;55:457–463. © 2010 Wiley‐Liss, Inc.

There are eight reported cases in the literature of osteosarcomas secreting β-hCG. Our primary aim was to investigate the rate of β-hCG expression in osteosarcoma and attempt to understand the characteristics of osteosarcomas that secrete β-hCG. We reviewed 37 histopathology slides (14 biopsies and 23 surgical specimens) from 32 patients with osteosarcoma. The slides were retrospectively stained for β-hCG expression. Patient and tumour characteristics, including age, gender, tumour location, subtype, proportion of necrosis, presence of metastases and recurrence were recorded. A total of five of the 32 tumours were found to be positive for β-hCG expression (one strongly and four weakly). This incidence of this expression was found in tumours with poor histological response to neoadjuvant chemotherapy.The use of β-hCG expression as a diagnostic, prognostic or follow-up marker is questionable and needs further investigation with a larger sample size.Human chorionic gonadotropin (hCG) is a glycoprotein which is usually produced by the placental syncytiotrophoblasts in healthy pregnant women from six to eight days after conception.

The efficacy of microsurgical free-tissue transfer for the treatment of chronic nonhealing infected diabetic foot ulcers was evaluated in a retrospective study. Between January 1992-December 1997, 10 patients underwent surgery at the American University of Beirut. Muscular free flaps were used to salvage 8 feet, and fasciocutaneous free flaps were used in 2 feet. The flap survival rate was 90%, a result that is equivalent to other series of microvascular tissue transfer in nondiabetic patients; the postoperative morbidity rate was comparable to that of nondiabetic patients. Infection control was achieved in 87.5% of patients. Seven of the 9 surviving patients had bipedal gait and were ambulatory, with full weight-bearing on their flaps at the end of the 2-year follow-up period. Microvascular free-tissue transfer can be used successfully for the salvage of infected diabetic foot ulcers.