We retrospectively analysed plain radiographs and MR imaging of 16 conventional osteosarcoma cases(8 children, 8 adults) which underwent amputations or limb salvage operations. Pathologic correlation was performed with gross and microscopic sections to evaluate 1) whether the open epiphyseal plate can function as a barrier against transphyseal spread of osteosarcoma and 2) the diagnostic value of MR imaging for the detection of the detection of the epiphyseal involvement of osteosarcoma. In children with open epiphyseal plates, conventional radiographs suggested transphyseal tumor growth in one of eight cases(12.5% and MR imaging in seven cases(87.5%). Pathologic examination confirmed epiphyseal involvement in six of seven cases noted with MR imaging(75%). On the the other hand, in adult patients with closed epiphyseal plates, conventional radiographs showed transphyseal tumor growth in six of eight cases(75%), while MR imaging and pathologic exam demonstrated tumor invasion in all cases(100%). We conclude that open epiphyseal plate does not function as and effective barrier against tumor extension, and MR imaging is an excellent method in detecting the extent of transphyseal tumor growth.
Adult ; Amputation ; Child ; Growth Plate ; Hand ; Humans ; Limb Salvage ; Magnetic Resonance Imaging* ; Methods ; Osteosarcoma* ; Retrospective Studies

Adolescent ; Female ; Gigantism ; diagnosis ; surgery ; Humans ; Limb Salvage ; methods ; Lipomatosis ; diagnosis ; surgery ; Upper Extremity ; pathology ; surgery

OBJECTIVETo compare mid-term clinical outcomes between amputation and limb salvage in treating severe open tibial fractures with type Gustilo III B, III C.

METHODSFrom July 2007 to June 2010,68 patients with severe open tibial fractures with type Gustilo III B, III C treated by amputation and limb salvage were retrospectively analyzed. In amputation group, there were 26 males and 12 females with an average age of (44.9±16.3) years old; and 21 cases were type Gustilo (III B, 17 cases were Gustilo III C; amputation were performed in accordance with soft tissue injury degree of shank, fracture types and surgical exploration. In limb salvageg group, there were 21 males and 9 females with an average age of (43.5±14.7) years old; and 23 cases were type Gustilo III B, 7 cases were Gustilo III C; the method of internal fixation and and wound healing were performed in accordance with patients's specific condition. Operative time, blood loss, hospital stay and postoperative infection was compared between two groups; time of loading and rate of return to work was compared; VAS scoring was used to evaluate condition of pain; SF-36 health queationaire was used to assess postoperative life quality.

RESULTSTotally 60 patients were followed up (33 cases in amputation group and 27 cases in limb salvage group) with an average time of 49.1 months. Operative time, blood loss, hospital stay and postoperative infection in amputation and limb salvage group respectively was (109.0±25.7) min, (245.0±58.6) min; (168.0±49.0) ml, (311.0±137.0) ml; (13.8±2.7) d, (28.8±13.1) d; 7.9%, 36.7%. At the final following-up, there was no significance meaning between two groups in VAS scoring and rate of return to work, but time of loading in amputation group was shorter than that of in limb salvage group. Physiological function in amputation group was better than limb salvage group, while body pain was worse; and there was no signicance meaning in psychological health between two groups.

CONCLUSIONAmputation and limb salvage both can treat severe open tibial fractures, and mid-term clinical outcomes between two groups has equivalent efficacy.

Adolescent ; Adult ; Aged ; Amputation ; methods ; Case-Control Studies ; Female ; Humans ; Limb Salvage ; methods ; Male ; Middle Aged ; Tibial Fractures ; surgery

INTRODUCTION: Percutaneous transluminal angioplasty (PTA) is commonly used to treat patients with chronic limb-threatening ischaemia (CLTI). This study aimed to examine the mortality and functional outcomes of patients with CLTI who predominantly had diabetes mellitus in a multi-ethnic Asian population in Singapore. METHODS: Patients with CLTI who underwent PTA between January 2015 and March 2017 at the Vascular Unit at Singapore General Hospital, Singapore, were studied. Primary outcome measures were 30-day unplanned readmission, two-year major lower extremity amputation (LEA), mortality rates, and ambulation status at one, six and 12 months. RESULTS: A total of 221 procedures were performed on 207 patients, of whom 184 (88.9%) were diabetics. The one-, six- and 12-month mortality rate was 7.7%, 16.4% and 21.7%, respectively. The two-year LEA rate was 30.0%. At six and 12 months, only 96 (46.4%) and 93 (44.9%) patients were ambulant, respectively. Multivariate analysis revealed that preoperative ambulatory status, haemoglobin, Wound Ischaemia and foot Infection (WIfI) score, and end-stage renal failure (ESRF) were independent predictors of one-year ambulatory status. Predictors of mortality at one, six and 12 months were ESRF, preoperative albumin level, impaired functional status and employment status. CONCLUSION PTA for CLTI was associated with low one-year mortality and two-year LEA rates but did not significantly improve ambulation status. ESRF and hypoalbuminaemia were independent predictors of mortality. ESRF/CKD and WIfI score were independent predictors of loss of ambulation at six months and one year. We need better risk stratification for patients with CLTI to decide between initial revascularisation and an immediate LEA policy.
Amputation ; Chronic Disease ; Chronic Limb-Threatening Ischemia ; Humans ; Ischemia/surgery* ; Limb Salvage/methods* ; Lower Extremity/surgery* ; Peripheral Arterial Disease/surgery* ; Retrospective Studies ; Risk Factors ; Singapore ; Treatment Outcome

Blood Vessel Prosthesis Implantation ; instrumentation ; methods ; Femoral Artery ; surgery ; Humans ; Limb Salvage ; Peripheral Vascular Diseases ; surgery ; Stents

Ameloblastoma in the tibia is rare. Limb reconstruction after tumor resection is challenging in terms of selection of the operative method. Here, we report a case of radical resection of an ameloblastoma in the mid-distal tibia combined with limb salvage using a three-dimensional (3D)-printed prosthesis replacement, with 1-year follow-up results. After receiving local institutional review board approval, a titanium alloy prosthesis was designed using a computer and manufactured with 3D-printing technology. During the operation, the stem of the prosthesis was inserted closely into the proximal tibial medullary cavity. Then, the metal ankle mortise and the talus were compacted closely. Radiographic results at 1-year follow up showed that the prosthesis was well placed, and no loosening was observed. The Musculoskeletal Tumor Society (MSTS) 93 functional score was 26 points, and the functional recovery percentage was 86.7%. Computer-assisted 3D-printing technology allowed for more volume and structural compatibility of the prosthesis, thereby ensuring a smooth operation and initial prosthetic stabilization. During the follow up, the presence of bone ingrowths on the porous surface of some segments of the prosthesis suggested good outcomes for long-term biological integration between the prosthesis and host bone.
Alloys ; Ameloblastoma ; Ankle ; Ethics Committees, Research ; Extremities ; Follow-Up Studies ; Limb Salvage ; Methods ; Prostheses and Implants ; Talus ; Tibia ; Titanium

OBJECTIVETo evaluate the proximal tibiofibular joint resection on the limb salvage for osteosarcoma of the proximal tibia.

METHODSBetween August 1995 and January 2004, 11 patients with osteosarcoma of proximal tibia and tibiofibular joint involved underwent resection and endoprosthetic proximal tibial replacement. Seven patients were male and 4 were female. The patients ranged in age from 14 to 23 years (mean 18 years). The surgical stage were IIB.

RESULTSThe follow-up period varied from 2 to 9 years (mean 59 months). Three patients died of pulmonary metastases, 1 patient was still alive with pulmonary metastasis, 1 patient underwent amputation for local recurrence. There was 1 early skin necrosis, 2 transient palsy of the common peroneal nerve, and 2 thrombus of lower limb vein. The mean postoperative Musculoskeletal Tumor Society score of the knee joint was 70% (range 55% - 86%), the mean postoperative range of motion was 85 degrees (range 0 degrees - 120 degrees ), and the extensor lag varied from 0 degrees to 20 degrees .

CONCLUSIONSLimb salvage for osteosarcoma of the proximal tibia with proximal tibiofibular joint resection and custom-made prosthesis reconstruction has had excellent results, however, the prevention and treatment of relevant complications should be given more attention.

Adolescent ; Adult ; Arthroplasty, Replacement, Knee ; methods ; Bone Neoplasms ; surgery ; Female ; Fibula ; Follow-Up Studies ; Humans ; Joints ; surgery ; Limb Salvage ; methods ; Male ; Osteosarcoma ; surgery ; Tibia ; Treatment Outcome

OBJECTIVETo discuss the reconstruction methods and treatment effects of osteosarcoma around the knee in skeletal immature children and adolescent patients.

METHODSBetween October 1996 and December 2005, 89 children and adolescent patients with osteosarcoma around the knee received limb salvage surgery. The average age was 13 years old. Tumor involved distal femur in 52 cases, proximal tibia in 36 cases, and both parts in one patient. Different limb salvage methods, including tumor recycle bone reimplantation (n = 20), partial endoprosthesis (n = 19) and total knee megaprosthesis replacement (n = 50) were chosen according to both the age of the patient and the skeletal. Expandable and special designed pediatric prosthesis some times might also be considered.

RESULTSAfter average follow up of 42 months, 4 cases of local recurrence and 11 of metastasis occurred in tumor recycle bone group; 1 case of local recurrence and 4 of metastasis in partial endoprosthesis group; another 4 cases of local recurrence and 9 patients died of disease in total knee megaprosthesis group. The five-year survival rate was 47.1%, 71.7% and 68.2% in 3 groups respectively. There were 3 deep infections in all the cases, 2 subluxations and 1 amputation after operation for limb ischemia in partial endoprosthesis group. The average functional score of MSTS 93 was 21.43 point, 23.40 point and 25.32 point; and the average leg length discrepancy was 5.48, 4.50 and 3.12 cm in 3 groups respectively.

CONCLUSIONSPartial-joint prosthesis or other methods which can avoid injury of the opposite epiphysis should be used to decrease the possibility of limb length discrepancy and ease the following revised arthroplasty. For patient with almost mature skeletal, total knee megaprosthesis may be a proper choice for better function result.

Adolescent ; Arthroplasty, Replacement, Knee ; methods ; Bone Neoplasms ; surgery ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Knee ; Limb Salvage ; methods ; Male ; Osteosarcoma ; surgery ; Replantation ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To evaluate the efficacy of transposition of the medial gastrocnemius muscle flap in the limb-salvage operation for proximal tibial osteosarcoma. METHODS: From January 2000 to January 2010, 65 patients [37 males, 28 females; (17.0±6.5) years] suffering from the proximal tibial osteosarcoma had a limb-salvage operation. According to the Enneking staging system, 35 patients were in stage IIa, 30 in stage IIb. All of the patients underwent resection of the osteosarcomas and reconstruction of the bone defect by prothesis. Among them, there were 35 patients underwent the medial head of the gastrocnemius muscle flap transposition to reconstruct the soft tissues and the other 30 didn't. RESULTS: All the patients were followed-up. In the group with the transposition of medial gastrocnemius muscle flap, the length of tumor bone resection was (13.5±4.2) cm, operation time was (150±45) min, intraoperative blood loss was (700±135) mL, and drainage volume was (500±200) mL. In the group without the transposition of medial gastrocnemius muscle flap, the length of tumor bone resection was (12.3±5.8) cm, operation time was (135±37) min, intraoperative blood loss was (600±105) mL, and drainage volume was (450±250) mL. There was significant difference in the operation time (P<0.05) but no significant difference in the intraoperative blood loss and drainage volume (P>0.05). In the group with the transposition of medial gastrocnemius muscle flap, local skin necrosis occurred in 2 patients (5.7%), and prosthesis deep infection occurred in 1 (2.9%). In the group without the transposition of medial gastrocnemius muscle flap, subctaneous hematocele, and effusion occurred in 3 (10.0%), wound infection occurred in 4 (13.3%), 1 cured and the other 3 developed prosthesis deep infection.There was significant difference in the rate of local complications (P<0.05). According to the function assessment by the Enneking system, in the group with the transposition of medial gastrocnemius muscle flap, 13 patients had excellent results, 17 had good results, 3 had fair results and 2 had poor results, with a satisfaction rate of 85.7%. In the group without the transposition of medial gastrocnemius muscle flap, 10 patients had excellent results, 12 had good results, 5 had fair results and 3 had poor results, with a satisfaction rate of 73.3%. There was significant difference in function assessment between the 2 groups (P<0.05). CONCLUSION The flap transposition of the medial head of the gastrocnemiusmuscle can reconstruct the soft tissue defect, decrease the local complication rate and improve the clinical outcomes of the limb-salvage for the proximal tibia osteosarcoma.
Adolescent ; Arthroplasty, Replacement ; Bone Neoplasms ; surgery ; Child ; Female ; Humans ; Limb Salvage ; methods ; Male ; Muscle, Skeletal ; Osteosarcoma ; surgery ; Reconstructive Surgical Procedures ; methods ; Surgical Flaps ; Tibia ; Young Adult

BACKGROUND: We report on our experience with using a distally based island flap for soft tissue reconstruction of the foot in limb salvage surgery for malignant melanoma patients. METHODS: A distally based sural flap was used for 10 cases for the hindfoot reconstruction, and a lateral supramalleolar flap was used for 3 cases for the lateral arch reconstruction of the mid- and forefoot after wide excision of malignant melanomas. RESULTS: The length of the flap varied from 7.5 cm to 12 cm (mean, 9.6 cm) and the width varied from 6.5 cm to 12 cm (mean, 8.8 cm). Superficial necrosis developed in four flaps, but this was successfully treated by debridement and suture or a skin graft. All thirteen flaps survived completely and they provided good contour, stable and durable coverage for normal weight bearing. CONCLUSIONS: The distally based sural flap is considered to be useful for reconstructing the hindfoot, and the lateral supramalleolar flap is good for reconstructing the lateral archs of the mid- and forefoot after resection of malignant melanoma of the foot.
Adult ; Aged ; Female ; Foot/*surgery ; Foot Diseases/*surgery ; *Free Tissue Flaps ; Humans ; Limb Salvage ; Male ; Melanoma/*surgery ; Middle Aged ; Reconstructive Surgical Procedures/methods ; Skin Neoplasms/*surgery