Closed Soft Tissue Injuries
CLOSED SOFT TISSUE INJURIES Closed injuries are characterized by variable degrees of damage to skin and underlying soft tissue and are an inevitable component of any fracture (see Plate 7-1)….
Limb-Salvage Procedures
ROTATIONPLASTY This reconstructive procedure is used in a skeletally immature patient after en bloc extra-articular resection of osteosarcoma about the knee (see Plate 6-33). The technique was devised by Van…
Limb-Salvage Procedures for Reconstruction
Two principles are recognized in limb-salvage surgery—careful, adequate excision of the tumor followed by optimal functional reconstruction of the limb. Patient lifestyle and expectations should be carefully considered when selecting…
Radiologic Findings in Limb-Salvage Procedures
RECONSTRUCTION OF DIAPHYSIS Reconstruction of the diaphysis (intercalary procedure) after tumor removal is achieved with bone grafts or prosthetic implants, or both (see Plates 6-31 and 6-32). Grafting alternatives include…
Reconstruction after Partial Excision or Curettage of Bone (Fracture Prophylaxis)
The potential for pathologic fracture is a common problem associated with metastatic carcinoma or myeloma. These tumors often present as painful osteolytic lesions in the lower limb, with pain on…
Surgical Margins
An intracapsular margin is obtained when the surgical dissection extends through the reactive zone and the capsule or pseudocapsule into the tumor itself. A marginal margin describes a plane of…
Tumor Biopsy
Correct Placement of Incision. In any limb, a straight longitudinal incision is used. The biopsy incision is placed in the line of the planned subsequent resection (if malignant) so that…
Sarcomas of Soft Tissue (Continued)
Diagnostic Studies. MRI is the best imaging modality for both rhabdomyosarcoma and leiomyosarcoma. Treatment/Prognosis. Rhabdomyosarcomas occur primarily in children, and there has been a significant improvement in survival rates in…
Sarcomas of Soft Tissue (Continued)
Diagnostic Studies. Liposarcoma is best imaged by MRI and will have at least some fat with high signal intensity on T1-weighted images. Dedifferentiated liposarcomas will have a large area of…
Sarcomas of Soft Tissue
Limb-salvage procedures (i.e., local excision) have replaced amputation as the primary treatment of soft tissue sarcomas; however, despite the efficacy of limb-salvage procedures in obtaining local control, pulmonary metastases remain…
