Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone

Background The shoulder is commonly affected by primary and metastatic tumors. Current surgical techniques for complex shoulder reconstruction frequently result in functional deficits and instability. A synthetic mesh used in vascular surgery has the biological properties to provide mechanical constraint and improve stability after tumor related shoulder reconstruction. Questions/purposes We describe (1) surgical technique using a synthetic mesh during humerus reconstructions; (2) functional level defined as shoulder ROM of patients undergoing the procedure; (3) incidence of postoperative dislocation and shoulder instability; and (4) complications associated with the use of the device. Methods We retrospectively reviewed 16 patients with proximal humerus replacements reconstructed with a synthetic mesh from February 2006 to July 2008. Patients were followed clinically and radiographically for a minimum of 13 months (mean, 26 months; range, 13-43 months).Results There were no shoulder dislocations at the latest followup. The mean shoulder flexion was 43°(range, 15°-170°) and mean shoulder abduction of 38 (range, 15°-110°). The mean operative time was 121 minutes (range, 80-170 minutes) and the mean blood loss was 220 mL (range, 50-750 mL).

Section: Introductionmentioning

confidence: 99%

Proximal and Total Humerus Reconstruction With the Use of an Aortograft Mesh

Marulanda

Henderson

Cheong

et al. 2010

“…The orthopaedic literature describes multiple surgical options for reconstruction after resection of a bone tumor of the distal femur, including custom total knee prosthesis [2, 3, 6-16, 19, 27, 33], osteoarticular allograft [1,20,[25][26][27]30], arthrodesis with intercalary bone grafting [9,32], rotationplasty [10], and ''condyle-sparing'' intercalary allograft [23,24]. Controversy remains concerning the optimal procedure with regard to functional outcome.…”

Section: Introductionmentioning

confidence: 99%

“…Although a few studies compare amputation, rotationplasty, and arthrodesis with endoprosthetic reconstruction [9,10,25,26,29], even fewer compare endoprostheses with intercalary allografts, one in an animal model and the other for tumors in the proximal tibia [4,17]. These few studies about the condyle-sparing or epiphyseal preservation technique have been case reports or series with less than 20 patients [4,23] but raise concerns regarding the adequacy of surgical margins and the risk of local recurrence when preserving the distal femoral condyle [23].…”

Section: Introductionmentioning

confidence: 99%

Megaprosthesis versus Condyle-sparing Intercalary Allograft: Distal Femoral Sarcoma

Zimel¹,

Cizik

Rapp³

et al. 2009

Although functionally appealing in preserving the native knee, the condyle-sparing intercalary allograft of the distal femur may be associated with a higher risk of tumor recurrence and endoprosthetic replacement for malignant distal femoral bone tumors. We therefore compared the risk of local tumor recurrence between patients in these two types of reconstruction groups. We retrospectively reviewed 85 patients (mean age, 22 years; range, 4-82 years), 38 (45%) of whom had a condyle-sparing allograft and 47 (55%) of whom had endoprostheses. The minimum followup for both groups was 2 years (mean, 7 years; range, 2-19 years). Local recurrences occurred in 11% (five of 47) of the patients having implants versus 18% (seven of 38) of the patients having allografts. Using time to local recurrence as an end point, the Kaplan-Meier

“…Complications after rotationplasty include wound infection, vascular compromise, nerve palsy, and nonunion with infection being the most severe complication of rotationplasty [12,14,19]. Our new incision technique may reduce the risk of soft tissue complications because the soft tissues can be sutured without tension as a result of better fitting of the proximal and distal incisions after resection.…”

Section: Discussionmentioning

confidence: 99%

A New Incision Technique to Reduce Tibiofemoral Mismatch in Rotationplasty

Ossendorf

Exner

Fuchs

2010

Rotationplasty provides stable and durable biologic reconstruction after tumor resection around the knee and renders reliable results, in young patients. However, after resection of the tumor, there is often a mismatch between the circumference of the proximal (femoral) and the distal (tibial) parts. Because rotationplasty includes an intercalary amputation where the ends are readapted, there is always a mismatch of the proximal and distal circumferences of the soft tissue envelope. To facilitate skin closure without tension and to avoid impaired wound healing and subsequent infections, the type of incision is critical and must be carefully planned. We present a new incision technique for rotationplasty about the knee. Half of the difference of the incision length of the proximal and distal circumferences represents the base of the triangle proximally, medially and laterally of the thigh. After adapting both ends, the peak of this flat triangle is distally adapted via a vertical incision which allows it to match unequal circumferences. This technique was used in eight patients, in all of whom the wounds healed uneventfully.