scholarly journals One-Stage Soft Tissue Reconstruction Following Sarcoma Excision: A Personalized Multidisciplinary Approach Called “Orthoplasty”

2020 ◽  
Vol 10 (4) ◽  
pp. 278
Author(s):  
Andrea Angelini ◽  
Cesare Tiengo ◽  
Regina Sonda ◽  
Antonio Berizzi ◽  
Franco Bassetto ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Lower Limbs ◽  
Surgical Approaches ◽  
Soft Tissue Reconstruction ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
One Stage ◽  
Unplanned Excision ◽  
Increased Risk ◽  
Toronto Extremity Salvage Score

Background and Objectives. Wide surgical resection is a relevant factor for local control in sarcomas. Plastic surgery is mandatory in demanding reconstructions. We analyzed patients treated by a multidisciplinary team to evaluate indications and surgical approaches, complications and therapeutic/functional outcomes. Methods. We analyzed 161 patients (86 males (53%), mean age 56 years) from 2006 to 2017. Patients were treated for their primary tumor (120, 75.5%) or after unplanned excision/recurrence (41, 25.5%). Sites included lower limbs (36.6%), upper limbs (19.2%), head/neck (21.1%), trunk (14.9%) and pelvis (8.1%). Orthoplasty has been considered for flaps (54), skin grafts (42), wide excisions (40) and other procedures (25). Results. At a mean follow-up of 5.3 years (range 2–10.5), patients continuously showed no evidence of disease (NED) in 130 cases (80.7%), were alive with disease (AWD) in 10 cases (6.2%) and were dead with disease (DWD) in 21 cases (13.0%). Overall, 62 patients (38.5%) developed a complication (56 minor (90.3%) and 6 major (9.7%)). Flap loss occurred in 5/48 patients (10.4%). The mean Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) was 74.8 ± 14 and 79.1 ± 13, respectively. Conclusions. Orthoplasty is a combined approach effective in management of sarcoma patients, maximizing adequate surgical resection, limb salvaging and functional recovery. One-stage reconstructions are technically feasible and are not associated with increased risk of complications.

scholarly journals Custom-Made 3D-Printed Implants as Novel Approach to Reconstructive Surgery after Oncologic Resection in Pediatric Patients

2021 ◽  
Vol 10 (5) ◽  
pp. 1056
Author(s):  
Giovanni Beltrami ◽  
Gabriele Ristori ◽  
Anna Maria Nucci ◽  
Alberto Galeotti ◽  
Angela Tamburini ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Soft Tissues ◽  
Lower Limbs ◽  
Host Bone ◽  
Limb Salvage Surgery ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Custom Made ◽  
3D Printed

Recently, custom-made 3D-printed prostheses have been introduced for limb salvage surgery in adult patients, but their use has not been described in pediatric patients. A series of 11 pediatric patients (mean age 10.8 years; range 2–13) with skeletal tumors treated with custom-made implants for the reconstruction of bony defects is described. Patients were followed up every 3 months. Functional results were evaluated by the Musculoskeletal Tumor Society Score (MSTS) for upper and lower limbs. The mean follow-up was 25.7 months (range 14–44). Three patients died after a mean of 19.3 months postoperatively—two because of disease progression and the other from a previous malignancy. Three patients experienced complications related to soft tissues. One patient required device removal, debridement, and antibiotic pearls for postoperative infection. Partial osseointegration between grafts and host bone was observed within a mean of 4 months. At the final follow-up, mean MSTS score was 75%. 3D prostheses may yield biological advantages due to possible integration with the host bone and also through the use of vascularized flaps. Further research is warranted.

scholarly journals Functional Outcome After Lower Extremity Soft Tissue Sarcoma Treatment: A Pilot Study Based on Translated and Culturally Adapted Measures

2018 ◽  
Vol 108 (2) ◽  
pp. 164-171
Author(s):  
G. Kask ◽  
I. Barner-Rasmussen ◽  
J. Repo ◽  
C. Blomqvist ◽  
E. Tukiainen
Keyword(s):  
Pilot Study ◽  
Soft Tissue ◽  
Soft Tissue Sarcoma ◽  
Lower Extremity ◽  
Functional Outcome ◽  
Soft Tissue Sarcomas ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Toronto Extremity Salvage Score ◽  
Extremity Salvage

Background and Aims: The present standard of care in treating lower extremity soft tissue sarcomas is function-sparing, limb-preserving resection and reconstruction with or without oncological therapy. The aim of this pilot study was to test the suitability and adequacy of the Finnish translations of two functional outcome questionnaires (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society score) and to perform a preliminary investigation of functional outcomes of Finnish lower-limb soft tissue sarcoma patients after operative treatment. Materials and Methods: Between June 2015 and December 2015, consecutive surgically treated outpatients were asked to participate in the study. Demographic, clinical, surgical, and oncological outcome data were collected. Two functional outcome questionnaires were used (Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores). A comparative analysis is presented. Results: A total of 19 lower-limb soft tissue sarcoma patients with a mean follow-up time of 2 years and 10 months were included. All (n = 19) invited patients participated in the study. Mean age was 62.3 years. In total, 13 had high-grade sarcomas. Eight wounds were closed directly, four used skin grafts, and five required flap reconstructions. One patient required a tumor prosthesis, and one required a rotationplasty. A total of 14 patients received oncological therapy. No problems or difficulties were reported in using and completing the Finnish versions of the Toronto Extremity Salvage Score or Musculoskeletal Tumor Society questionnaires. The overall Toronto Extremity Salvage Score and Musculoskeletal Tumor Society scores were 88 and 76, respectively. Conclusion: This pilot study suggests that the Finnish versions of the Toronto Extremity Salvage Score and Musculoskeletal Tumor Society questionnaires are suitable for measuring functional outcome after lower extremity soft tissue sarcomas treatment. Functional outcomes vary from moderate to excellent.

scholarly journals The Bateman-Type Soft Tissue Reconstruction around Proximal or Total Humeral Megaprostheses in Patients with Primary Malignant Bone Tumors—Functional Outcome and Endoprosthetic Complications

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 3971
Author(s):  
Helmut Ahrens ◽  
Christoph Theil ◽  
Georg Gosheger ◽  
Robert Rödl ◽  
Niklas Deventer ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Functional Outcome ◽  
Bone Tumor ◽  
Revision Surgery ◽  
Soft Tissue Reconstruction ◽  
Malignant Bone Tumor ◽  
Musculoskeletal Tumor Society ◽  
Primary Malignant Bone Tumor ◽  
Toronto Extremity Salvage Score ◽  
Tissue Reconstruction

We aimed to evaluate the functional outcome and endoprosthetic complications following the Bateman-type soft tissue reconstruction around proximal or total humeral replacements in patients undergoing resection of a primary malignant bone tumor. Between September 2001 and December 2018, a total of 102 patients underwent resection of a primary malignant bone tumor and subsequent reconstruction with a modular humeral megaprosthesis in our department. Fifteen (15%) of these patients underwent a Bateman-type soft tissue reconstruction and were included in this retrospective study. The median Musculoskeletal Tumor Society (MSTS) score was 21, the median Toronto Extremity Salvage Score (TESS) was 70, and the median American Shoulder and Elbow Surgeons (ASES) score was 72. Fifty-three percent (8/15) of all patients required a revision surgery after a median time of 6 months. There were 2 soft tissue failures, 3 infections and 3 tumor recurrences. The revision-free implant survivorship amounted to 53% (95% confidence interval (CI) 28–81) after 1 year and 47% (95% CI 22–73) at last follow-up. The Bateman-type reconstruction is a feasible option for soft tissue reconstruction but functional outcome is overall limited and the risk for revision surgery within the first postoperative year is high.

Is frozen tumour-bearing autograft with concurrent vascularized fibula an alternative to the Capanna technique for the intercalary reconstruction after resection of osteosarcoma in the lower limb?

2020 ◽  
Vol 102-B (5) ◽  
pp. 646-652
Author(s):  
Yajie Lu ◽  
Haodong Zhu ◽  
Mengquan Huang ◽  
Chunlin Zhang ◽  
Guojing Chen ◽  
...  
Keyword(s):  
Lower Limbs ◽  
Fibular Graft ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Tumour Bearing ◽  
Significant Difference ◽  
Vascularized Fibula ◽  
Duration Of Surgery ◽  
Group 2 ◽  
Group 1

Aims The use of frozen tumour-bearing autograft combined with a vascularized fibular graft (VFG) represents a new technique for biological reconstruction of massive bone defect. We have compared the clinical outcomes between this technique and Capanna reconstruction. Methods From June 2011 to January 2016 a retrospective study was carried out of patients with primary osteosarcoma of lower limbs who underwent combined biological intercalary reconstruction. Patients were categorized into two groups based on the reconstructive technique: frozen tumour-bearing autograft combined with concurrent VFG (Group 1) and the Capanna method (Group 2). Demographics, operating procedures, oncological outcomes, graft union, limb function, and postoperative complications were compared. Results A total of 23 patients were identified for analysis: eight in Group 1 and 15 in Group 2. There was no difference in the demographics (age, sex, and affected site) and operating procedures (resection length, duration of surgery, and blood loss) between the two groups. No significant difference was found in local recurrence in Group 1 versus Group 2 (p = 0.585). Mean union time for the frozen autograft-host junction was 8.4 months (7.0 to 11.0), significantly earlier than for the allograft-host junction in Group 2 (mean 14.1 months (10.0 to 28.0); p < 0.001). Mean Musculoskeletal Tumor Society scores in groups 1 and 2 were 90.3% (SD 7.4%) and 88.0% (SD 9.0%), respectively, with no significant statistical difference (p = 0.535). In terms of complications, infection (n = 1, 6.7%) and delayed union (n = 2, 13.3%) occurred in Group 2, but no such complications were observed in Group 1. Conclusion Frozen tumour-bearing autograft in combination with VFG can be used as an alternative to the Capanna reconstruction in properly selected patients with osteosarcoma. Cite this article: Bone Joint J 2020;102-B(5):646–652.

scholarly journals Reconstructions of the Shoulder following Tumour Resection

2007 ◽  
Vol 15 (2) ◽  
pp. 201-206 ◽  
Author(s):  
Y Kitagawa ◽  
DM Thai ◽  
PFM Choong
Keyword(s):  
Soft Tissue ◽  
Postoperative Complications ◽  
Revision Surgery ◽  
Tumour Resection ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Toronto Extremity Salvage Score ◽  
Functional Assessments ◽  
Extremity Salvage ◽  
Effective Function

Purpose. To review and compare the postoperative outcomes of 3 types of shoulder reconstructions: prosthetic arthroplasty, clavicula pro humero reconstruction, and allograft arthrodesis. Methods. Records of 25 shoulder reconstructions following tumour resection were retrospectively reviewed. Perioperative data, oncological prognoses, postoperative complications, and functions were assessed. Results. We performed 10 prosthetic arthroplasties, 7 clavicula pro humero procedures, 4 allograft arthrodeses, and 4 soft tissue reconstructions. Eight patients died of their diseases. Three developed complications and underwent revision surgery. 19 patients achieved stable shoulders. Ten patients attended for functional assessments. Respective mean scores using the Musculoskeletal Tumor Society-International Symposium on Limb Salvage and the Toronto Extremity Salvage Score were: 77% and 82% for prosthetic arthroplasties, 67% and 62% for clavicula pro humero procedures, 83% and 70% for allograft arthrodeses, and 93% and 98% for soft tissue reconstructions. Conclusion. A stable construct is the treatment goal for shoulder reconstructions, as it enables effective function of the arm and hand.

En bloc resection of pelvic sarcomas with sacral invasion

2018 ◽  
Vol 100-B (6) ◽  
pp. 798-805 ◽  
Author(s):  
Y. Zhang ◽  
W. Guo ◽  
X. Tang ◽  
R. Yang ◽  
T. Ji ◽  
...  
Keyword(s):  
Operating Time ◽  
Surgical Approaches ◽  
New Classification ◽  
En Bloc ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Ps Ii ◽  
Pelvic Tumour ◽  
Ps I ◽  
The Mean

AimsThe sacrum is frequently invaded by a pelvic tumour. The aim of this study was to review our experience of treating this group of patients and to identify the feasibility of a new surgical classification in the management of these tumours.Patients and MethodsWe reviewed 141 patients who, between 2005 and 2014, had undergone surgical excision of a pelvic tumour with invasion of the sacrum. In a new classification, pelvisacral (Ps) I, II, and III resections refer to a sagittal osteotomy through the ipsilateral wing of the sacrum, through the sacral midline, or lateral to the contralateral sacral foramina, respectively. A Ps a resection describes a pelvic osteotomy through the ilium and a Ps b resection describes a concurrent resection of the acetabulum with osteotomies performed through the pubis and ischium or the pubic symphysis. Within each type, surgical approaches were standardized to guide resection of the tumour.ResultsThe mean operating time was 5.2 hours (sd 1.7) and the mean intraoperative blood loss was 1895 ml (sd 1070). Adequate margins were achieved in 112 (79.4%) of 141 patients. Nonetheless, 30 patients (21.3%) had local recurrence. The mean Musculoskeletal Tumor Society (MSTS93) lower-limb function score was 68% (sd 19; 17 to 100). According to the proposed classification, 92 patients (65%) underwent a Ps I resection, 33 patients (23%) a Ps II resection, and 16 (11%) patients a Ps III resection. Overall, 82 (58%) patients underwent a Ps a resection and 59 (42%) patient a Ps b resections. The new classification predicted surgical outcome.ConclusionWe propose a comprehensive classification of surgical approaches for tumours of the pelvis with sacral invasion. Analysis showed that this classification helped in the surgical management of such patients and had predictive value for surgical outcomes. Cite this article: Bone Joint J 2018;100-B:798–805.

scholarly journals O impacto da fisioterapia na funcionalidade após ressecção tumoral através da sacrectomia parcial associado à técnica de criocongelamento: relato de caso / The impact of physical therapy on functionality after tumor resonance through sacrectomy partially associated with criocogelament technique: case report

2019 ◽  
Vol 64 (2) ◽  
pp. 174
Author(s):  
José Carlos Alves Fabrício Júnior ◽  
Andréia Basta ◽  
Eduardo Yonamine Sadao ◽  
Karen Voltan ◽  
Letícia Correia Monte ◽  
...  
Keyword(s):  
Case Report ◽  
Physical Therapy ◽  
Physical Therapy Modalities ◽  
Functional Improvement ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Toronto Extremity Salvage Score ◽  
One Year ◽  
The Impact ◽  
Extremity Salvage

Introdução: Tumores ósseos malignos consistem aproximadamente 7% das neoplasias primárias em indivíduos menores de 20 anos de idade. Dentre todos esses, a maior prevalência é do Osteossarcoma, ocorrendo em 8,7 casos/milhão e seguido pelo Sarcoma de Ewing com 2,9 casos/milhão. Objetivo: Descrever o efeito da fisioterapia na funcionalidade do paciente submetido à ressecção tumoral através da sacrectomia parcial associado ao Criocongelamento. Relato de Caso: Paciente do sexo feminino LCM de 26 anos com queixa de dor lombar a 2 anos e um abaulamento na região do sacro, apresentou imagem de ressonância magnética sugestiva de neoplasia na região anterior ao Sacro. Após investigação com grupo do Tumor da IMSC-SP e através da biópsia foi diagnosticado um cordoma de Sacro. No dia 17 de maio foi realizada a ressecção da lesão através de uma sacrectomia parcial associado à técnica de criocongelamento. Após a cirurgia a paciente recebeu acompanhamento com a equipe de fisioterapia realizando uma avaliação funcional através do Escore Musculoskeletal Tumor Society (MSTS) e o Toronto Extremity Salvage Score – TESS. Resultados:  De acordo com escore MSTS após um ano de tratamento a paciente apresentou Pré-tratamento (Ruim), Pós-Tratamento (Bom), o escore TESS paciente melhorou de 28% para 48%. Conclusão: O acompanhamento multidisciplinar do grupo do Tumor e a equipe de fisioterapia se mostrou eficaz garantindo em 1 ano de tratamento uma melhora funcional de acordo com os escores aplicados.Descritores: Oncologia, Sacro/cirurgia, Cordoma,  Modalidade de fisioterapia, Crioterapia/métodos, Criocirurgia/métodosABSTRACT:Introduction: Malignant bone tumors comprise approximately 7% of primary neoplasms in patients under 20 years of age. Among all these, the highest prevalence is in osteosarcoma, occurring in 8.7 cases / million, followed by Ewing's sarcoma with 2.9 casos/milhão. Objective: To describe the intervention of Physical Therapy after criocongelamento Sacro. Case Report: A female patient LCM of 26 years complaining of back pain at 2 years and a bulging in the sacral region, magnetic resonance imaging showed suggestive of neoplasia in the region prior to the Sacro. After investigation with the group Tumor IMSC-SP and through biopsy was diagnosed with chordoma of Sacro. On the 17th of May was performed resection of the lesion through a partial sacrectomia associated with criocongelamento technique. After surgery the patient was monitored with the physiotherapy team performing a functional assessment score through the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score - TESS. Results: According to MSTS score after one year of treatment the patient had pretreatment (Bad), Post-Treatment (good), the TESS score patient improved from 28% to 48%. Conclusion: The multidisciplinary group of Tumor and physiotherapy team was effective providing at 1 year of treatment one functional improvement according scores applied.Key words: Medical oncology, Sacrum/surgery, Chordoma, Physical therapy modalities, Cryotherapy/methods, Cryosurgery/methods

scholarly journals Outcomes of Tumor Resection and Reconstruction by Megaprosthesis around Knee: Our Experience

2021 ◽  
Vol 11 (3) ◽  
Author(s):  
Bikram Kesari Kar ◽  
Mukund Madhav Ojha ◽  
Sandeep Kumar Yadav ◽  
Alok Chandra Agrawal ◽  
Harshal Sakale
Keyword(s):  
Local Recurrence ◽  
Limb Salvage ◽  
Lower Limbs ◽  
Implant Failure ◽  
Limb Salvage Surgery ◽  
Musculoskeletal Tumor ◽  
Musculoskeletal Tumor Society ◽  
Prosthetic Reconstruction ◽  
Msts Score

Introduction: In this modern era, limb reconstructive surgeries have become a standardized procedure for malignant tumor of lower limbs. We performed limb salvage surgeries for tumor around the knee with en bloc resection and subsequent reconstruction with a megaprosthesis. Methods: A total of six cases of malignant and locally aggressive tumor around the knee were operated on from 2017 to 2018, with resection and mega prosthetic reconstruction. Interpretation of functional outcome after surgery was performed with musculoskeletal tumor society (MSTS) score. Complications such as infection, local recurrence of tumor, implant failure, and distant metastases were evaluated during each follow-up. Results: Postoperatively, one patient developed superficial infection; one local recurrence with metastasis and the rest cases were uneventful. Patients were regularly followed for atleast1 year, and none of them developed any sign of deep infection, implant failure,or loosening. At the beginning of treatment, the average MSTS score was 8.83, which showed a significant increment to 25.83 after 12 months of follow-up. Conclusion: Albeit few cases were operated on, we draw this inference from our short-term experience that mega prosthesis acts as a boon to orthopedic surgeons in musculoskeletal tumor management, thereby uplifting the quality of life of patients even during terminal care. Keywords: Limb salvage surgery, osteosarcoma, giant cell tumor, megaprosthesis.

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