Resection of Thumb Metacarpal Ewing Sarcoma and Primary Reconstruction with Non-Vascularized Osteoarticular Metatarsal Autograft

Ewing sarcoma is a primary bone malignancy that rarely occurs in the hand. Resection and reconstruction will usually result in reduced or loss of thumb function. We describe a case of successful transplantation of nonvascularized osteoarticular second metatarsal autograft following wide resection of Ewing sarcoma of first metacarpal in an 11-year-old girl. The capsule of the graft’s metatarso-phalangeal joint was repaired to achieve mobility of the joint. This enabled preservation of thumb function by a relatively simple surgical technique. Detailed surgical procedures and excellence function after 2 years following surgery are described

Soft Tissue Reconstruction following Hemipelvectomy: Eight-Year Experience and Literature Review

Background and Objectives. Hemipelvectomy is a major surgical procedure that associates with significant morbidity, functional impairment, and psychological and body image problem. Reconstruction of the defect is a challenged since a large amount of composite tissues are needed. We would like to share our eight-year experience with massive pelvic resection and reconstruction. Methods. A retrospective analysis of all cases of hemipelvectomy was conducted in our institution over eight-year period with particular attention given to the reconstruction choices and associated complications. Results. Thirteen patients were included with median age of 39 years (range 13–78) of which all had advanced tumour with stage IIb (54%) and Stage III (46%). External hemipelvectomy was performed in all cases, and resultant defects were reconstructed with variety type of flaps. These include fillet thigh flaps, regional pedicle flaps of different designs, and free flap. Conclusions. Massive pelvic tumour is rarely encountered in our population but can be seen across all age groups and usually due to late presentation. The defects should be reconstructed using local or regional flaps, incorporating the muscle component to enhance flap perfusion. The tissue should be harvested from the amputated limb, as it can limit the donor site morbidity

Early Functional Outcome of Resection and Endoprosthesis Replacement for Primary Tumor around the Knee

We evaluated functional outcomes for patients who underwent surgery for resection and endoprosthesis replacement for primary tumours around the knee. We used the Musculoskeletal Tumour Society Scoring System (MSTS) for functional evaluations to compare differences between distal femur (DF) and proximal tibia (PT) placements. The study sample included 34 cases of distal femur and 20 cases of proximal tibia endoprosthesis replacement. Primary tumours were classified as follows: 33 osteosarcoma, 20 stage III giant cell tumour (GCT) and one case of mesenchymal chondrosarcoma. The mean MSTS score for both DF and PT endoprosthesis together was 21.13 (70.43%), and The MSTS scores for DF was 21.94 (73.13%) and PT was 19.75 (65.83%) Infection developed in 7 cases and 5 of which were PT endoprosthesis cases. Three deep infections required early, two-stage revision and resulted in poor MSTS scores. We conclude that endoprosthesis replacement for primary bone tumours had early good to excellent functional outcome. There were no differences in functional outcomes when comparing distal femur endoprostheses with proximal tibia endoprostheses

Outcome of Surgical Treatment of Pelvic Osteosarcoma: Hospital Universiti Sains Malaysia Experience

We reviewed the surgical treatment and outcomes of 13 patients with pelvic osteosarcoma treated in our centre in the past decade. The study sample included 9 males and 4 females with a mean age of 28.1 years. Four patients had ileal lesions, five had acetabulum lesions, one had a ischiopubis lesion, and three had involvement of the whole hemipelvis. Seven patients presented with distant metastases at diagnosis. Limb salvage was performed in 6 patients and amputation in 7. In 60% of cases in the limb salvage surgery group, we attempted wide resection with positive microscopic margin compared to only 16.7% in the amputation group. Local recurrence was higher in the limb salvage group. Overall survival was 18 months for mean follow up of 14.8 months. Median survival was 19 months in the limb salvage group compared to 9 months in amputation group. The outcome of surgical treatment of pelvic osteosarcoma remains poor despite advancements in musculoskeletal oncology treatment

Comparative Study Between Coaptive Film Versus Suture For Wound Closure After Long Bone Fracture Fixation

INTRODUCTION: Coaptive film (i.e., Steri-StripsTM) is an adhesive tape used to replace sutures in wound closure. The use of coaptive film for wound closure after long bone fracture fixation has not been well documented in the literature. METHODS: The aim of this prospective, randomized controlled trial comparing coaptive film with sutures for wound closure after long bone fracture fixation was skin closure time, incidence of wound complications and scar width at 12 week follow-up. Forty-five patients underwent femur fracture fixation (22 patients’ wound closed with sutures, 23 with coaptive film). RESULTS: The mean time for skin closure using coaptive film was 171.13 seconds compared to 437.27 seconds using suture. The mean wound lengths in the coaptive film group and suture group were 187.65 mm and 196.73 mm, respectively. One patient in each group had wound complications. CONCLUSION: Coaptive film is a time-saving procedure for skin closure following long bone fracture fixation. There is no difference in the incidence of wound complications and scar width between these two methods of skin closure

Long-term Outcome of Total Femur Replacement

Introduction: Total femur replacement is an option instead of amputation for extensive bone tumour or after revision surgery with a massive bone loss. Over a long period of time the patients may need revision surgery, and this might affect the functional outcome. We reviewed all consecutive total femur replacements done for primary and revision surgery of primary bone tumours in our centre to evaluate the long-term functional outcome and survival. Materials and methods: All patients who had total femur resection and reconstruction with modular endoprosthesis replacement in our centre from June 1997 to May 2022 were reviewed. The respondents were surveyed through WhatsApp using google form which was translated into Bahasa Malaysia based on the Musculoskeletal Tumour Society Scoring System (MSTS). The data were presented as descriptive data on the final survival of the limb and prosthesis. Results: Ten patients underwent total femur replacement. There were eight osteosarcoma, one giant cell tumour and one chondromyxoid fibroma. Three patients with osteosarcoma succumbed to pulmonary metastases; all had good early post-operative functional outcomes without local recurrence. Seven patients were available for long term evaluation of function with a mean follow-up of 17.6 years (ranged 10-25 years). Four patients with total femur replacement had good functional outcomes (60-80%) without revision with 10-25 years follow-up. Three patients experienced acetabulum erosion and chronic pain that required early hip replacements. Two of them were complicated with superior erosions and bone loss and subsequently were managed with massive reconstruction using cemented acetabulum cage reconstruction. The other has diabetes mellitus with chronic infection following revision of distal femur endoprosthesis to total femur replacement and subsequently underwent limited hemipelvectomy after 14 years. Conclusion: Total femur replacement offers a good long term functional outcome and prosthesis survival and is a favourable option for limb salvage surgery

Management of extensive surgical wounds of the extremity after tumour resections using two simultaneous composite flaps: two case reports

Tumour surgery for locally extensive malignant neoplasms of the extremity will sometimes result in extensive composite soft tissue defect. Local flaps are usually inadequate to cover these large defects. More than one tissue flap might be required to cover any exposed neurovascular structures, bone or prosthesis. We present two cases where two composite flaps were simultaneously used to cover extensive surgical defects after ablative tumour resections in the extremity. These resulted in uncomplicated wound healing and limb salvage

Giant Solitary Forearm Exostosis in A Child

Forearm deformity secondary to giant solitary ulna exostosis is rare. We describe a rare presentation of symptomatic solitary giant exostosis involving the entire distal ulna resulting in ulnar bowing of the forearm in a five-year-old boy. The tumour was completely resected and the defect was reconstructed with an allograft wrapped with a free autogenous periosteal tubular sleeve to deliver fresh pluripotential cells for better incorporation and integration. The distal ulna physes was preserved. An osteotomy was performed on the radius to correct the deformity. One year after surgery, the deformity remains corrected with normal bone length and excellent hand function. There is no evidence of local recurrence and the allograft has fully incorporated