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…
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…
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…
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…
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…
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…
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…
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…
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…
Diagnostic Studies. On MRI, tumor margins are sometimes difficult to distinguish from the normal fascial structures. Treatment/Prognosis. Treatment of desmoids has historically been by excision or resection, but based on…
