Surgical Procedures of Bone Tumors

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The goal of treatment is to remove the lesion with minimal risk of local recurrence.

Limb Salvage

  • Criteria for limb salvage:

    1. local control of the lesion must be at least equal to amputation
    2. the saved limb must be functional
  • Types of osseous resection

    1. Inter calary (between joints)
    2. Intra articular (one side of joint)
    3. Extra articular (both sides of the joint)
  • Various methods of salvage eg, endoprosthesis, allograft, composite, arthrodesis (allograft)
  • Relative contraindications

    1. Pathological fractures
    2. Skeletal immaturity
    3. Must be in an anatomical location which favours reconstruction and allows wide surgical margins
    4. The presence of distal metastasis is not a contraindication

Surgical Margins (Musculoskeletal Tumour Society):surgical-margins

  1. Intra-lesional 

    • through the tumour
    • leaves macroscopic tumour
    • not therapeutic
  2. Marginal 

    • through pseudo-capsule of tumour / reactive zone (contains inflammatory cells, oedema, fibrous tissue, satellites of tumour cells)
    • controls non-invasive benign tumours
    • recurrence of malignant tumours = 25-50% 
  3. Wide

    • around reactive zone, leaving a cuff of normal tissue
    • skip lesions left
    • recurrence of malignant tumours = < 10% 
  4. Radical 

    • removal of entire compartment or compartments
    • distant metastases left
  5. Amputation amputation-enneking

    • should be thought of as a form of reconstruction where surgical control of the tumour precludes useful function.

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