Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.242
Filtrar
1.
J Surg Oncol ; 121(6): 945-951, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32020627

RESUMO

BACKGROUND AND OBJECTIVES: Standard treatment for extremity sarcoma is limb-sparing surgery often with radiation, but complications occur frequently. We sought to determine factors predictive of wound complications after thigh sarcoma resection and reconstruction while analyzing trends over time. METHODS: We reviewed all thigh defects requiring plastic surgeon reconstruction following sarcoma resection at our institution from 1997 to 2014. Patient demographics, comorbidities, operative characteristics, multi-modality therapies, and complications were analyzed. Wound complications were: infection, dehiscence, seroma, hematoma, or partial/total flap loss. RESULTS: There were 159 thigh reconstructions followed for 30 months on average. Eighty-seven percent of patients underwent radiation and 42% had chemotherapy. Almost half (49.1%) had a complication. The most common wound complication was surgical site infection (23.3%) followed by dehiscence (19.5%), and seroma (10.7%). Less common were partial (2.5%) or total flap loss (0.6%). Reoperation was required in 21 patients (13.2%). Tobacco use, older patient age, cardiac disease, and higher body mass index were independently associated with wound complications. Complications trended towards decreasing over time, but this was not statistically significant. CONCLUSIONS: Tobacco use, cardiac disease, and higher body mass index, but not the timing of reconstruction, appear to increase the risk of wound complications after thigh soft tissue sarcomas resection and plastic surgery reconstruction.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Sarcoma/cirurgia , Coxa da Perna/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Procedimentos Cirúrgicos de Citorredução/métodos , Feminino , Humanos , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Sarcoma/tratamento farmacológico , Sarcoma/patologia , Sarcoma/radioterapia , Adulto Jovem
2.
J Surg Oncol ; 121(4): 612-619, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31919856

RESUMO

BACKGROUND AND OBJECTIVES: We aimed to identify the overall survival (OS), surgical complications, survival of reconstruction, and functional outcome of patients who underwent extra-articular resection of the shoulder joint for primary bone sarcomas. The OS and local recurrence rates in patients who underwent an amputation were also evaluated for comparison. METHODS: Thirty-two patients treated between 1988 and 2017 were studied. The tumours were located in the humerus in 22 (69%) and scapula in 10 patients (31%). The resection types were Malawer type IV in 6 (19%), type V in 21 (66%), and type VI in 5 patients (15%). Reconstruction was performed with endoprosthesis in 23 patients (72%) while excision arthroplasty with the suspension of the humerus to the clavicle was performed in 9 patients (28%). Surgical margins were wide in 16, marginal in 8, intralesional in 3, and not available in 5 patients. During the study period, 40 patients underwent a forequarter amputation and 11 patients underwent a shoulder disarticulation. RESULTS: The 5-year OS for patients who underwent extra-articular resection of the shoulder joint was 42% which was not statistically different compared with that of patients who underwent amputation (5-year OS = 30%; P = .091). The 5-year survival of the reconstruction was 94%, similar for endoprosthesis and excision arthroplasty. Local recurrence and complications developed in 6 (19%) and 10 patients (31%), respectively. Failures of the reconstruction requiring revision surgery occurred in two patients (6%). Limb salvage was achieved in 30 patients (94%). The median Musculoskeletal Tumour Society functional score was 61% (interquartile range, 57%-70%) and was similar in the endoprosthesis and excision arthroplasty group. CONCLUSIONS: Extra-articular resection of the shoulder joint for bone sarcomas is an effective limb-salvage method. However, local recurrence remains a principal concern.


Assuntos
Neoplasias Ósseas/cirurgia , Salvamento de Membro/métodos , Osteossarcoma/cirurgia , Articulação do Ombro/cirurgia , Adolescente , Adulto , Amputação/efeitos adversos , Amputação/métodos , Amputação/mortalidade , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Desarticulação/efeitos adversos , Desarticulação/métodos , Desarticulação/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Salvamento de Membro/efeitos adversos , Salvamento de Membro/mortalidade , Masculino , Pessoa de Meia-Idade , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Articulação do Ombro/patologia , Adulto Jovem
3.
J Surg Oncol ; 121(4): 630-637, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31957034

RESUMO

BACKGROUND AND OBJECTIVES: Limb salvage surgery remains the standard treatment in bone and soft tissue tumors. Toronto Extremity Salvage Score (TESS) is the most used quality of life measure. Our objective was to perform cross-cultural adaptation and validation in Italian, testing test-retest reliability, construct validity, and responsiveness. METHODS: We interviewed patients already treated for content validity. A total of 124 patients completed TESS and other questionnaires presurgery, at 3 months, 3 months + 2 weeks, and 6 months follow-up. We calculated intraclass correlation coefficients (ICCs) for reliability, associations with Pearson's r, and change over time with paired T tests. RESULTS: A new item regarding touch-screen devices was added to the upper extremity (UE) questionnaire. ICC resulted of 0.99 for lower extremity (LE) and 0.98 for UE patients, Pearson's r between TESS and Musculoskeletal Tumor Society was .66 and .64, EuroQol-5D-5L r was .62 and .61, and r between TESS and short form-36 physical function subscale was .76 and .71 for LE and UE groups, respectively. Paired T test results were statistically significant to detect change over time (0.03, 0.04, and 0.04 for LE groups and 0.03, 0.01, and 0.04 for UE groups). CONCLUSION: The Italian version of TESS can be used for the bone and soft tissue sarcoma population in clinical trials in Italy and with Italian speaking patients abroad to ensure patients' perspectives for efficacy and efficiency of treatments.


Assuntos
Neoplasias Ósseas/psicologia , Neoplasias Ósseas/cirurgia , Salvamento de Membro/psicologia , Osteossarcoma/psicologia , Osteossarcoma/cirurgia , Sarcoma/psicologia , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Comparação Transcultural , Extremidades/patologia , Extremidades/cirurgia , Feminino , Humanos , Itália , Idioma , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Osteossarcoma/patologia , Qualidade de Vida , Reprodutibilidade dos Testes , Sarcoma/patologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Tradução , Adulto Jovem
4.
Eur J Vasc Endovasc Surg ; 59(2): 265-275, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31889657

RESUMO

OBJECTIVE: The aim was to review and analyse the literature on clinical outcomes of drug coated balloon (DCB) vs. standard percutaneous transluminal angioplasty (PTA) for the treatment of infrapopliteal arterial disease. METHODS: This is a systematic review and meta-analysis. The MEDLINE, EMBASE and Cochrane Database of Systematic Reviews were searched for studies published between January 2008 and November 2018. Two authors independently performed the search, study selection, assessment of methodological quality and data extraction. Studies were eligible when reporting PTA and DCB outcomes in infrapopliteal arteries, published in English, human studies, and full text was available. Methodological quality was determined by MINORS and Cochrane risk of bias tool. GRADE methodology was used to rate the evidence for observed outcomes. The primary outcome was the 12 month limb salvage rate. Secondary outcomes were 12 month survival, amputation free survival (AFS), restenosis, and target lesion revascularisation (TLR) rates. Inclusion criteria for pooling data were randomised controlled trials and comparative studies with 12 month outcomes. RESULTS: Ten studies representing 1593 patients met the inclusion criteria. The quality was assessed as moderate or low. Data from five studies were pooled, and 12 month outcomes for DCB vs. PTA were limb salvage rate, 94.0% vs. 95.7% (odds ratio (OR), 0.92; 95% confidence interval (CI), 0.39-2.21); and survival rate, 89.8% vs. 92.9% (OR 0.69; 95% CI 0.39-1.21). Data from four studies were pooled, and 12 month outcomes for PTA vs. DCB were restenosis rate, 62.0% vs. 32.9% (OR 2.87; 95% CI 0.83-9.92); and TLR rate, 27.8% vs. 14.0% (OR 2.76; 95% CI 0.90-8.48). Pooled data from two studies showed 12 month AFS rate for DCB vs. PTA; 82.5% vs. 88.7% (OR 0.79; 95% CI 0.23-2.75). No statistically significant differences were found. CONCLUSION: Based on this systematic review and meta-analysis no significant differences in limb salvage, survival, restenosis, TLR, and AFS rates were found when DCB angioplasty was compared with standard PTA.


Assuntos
Angioplastia com Balão/instrumentação , Materiais Revestidos Biocompatíveis , Salvamento de Membro/métodos , Doença Arterial Periférica/cirurgia , Amputação/estatística & dados numéricos , Angioplastia com Balão/métodos , Stents Farmacológicos , Artéria Femoral/cirurgia , Humanos , Salvamento de Membro/instrumentação , Paclitaxel/administração & dosagem , Doença Arterial Periférica/mortalidade , Artéria Poplítea/cirurgia , Análise de Sobrevida , Resultado do Tratamento , Grau de Desobstrução Vascular
5.
Anticancer Res ; 39(12): 6807-6811, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810946

RESUMO

BACKGROUND/AIM: Controversy exists between performing limb salvage or amputation to treat osteosarcoma of the upper extremities. Our aim was to review the characteristics associated with limb amputation due to osteosarcoma of the upper extremities. PATIENTS AND METHODS: A descriptive study was performed by querying the National Cancer Database from January 1, 2004 to December 31, 2015. Statistical analysis was performed using chi-squared test and a multivariate logistic regression model. RESULTS: A total of 777 patients diagnosed with osteosarcoma of the upper extremities who underwent surgery met the inclusion criteria. Patients between 61 and 80 years were less likely to undergo limb amputation. Moreover, facilities located in the South Atlantic region, and stage IV of the disease were factors independently positively associated with amputation. CONCLUSION: Patients in facilities located in the South Atlantic region and those with stage IV disease were more likely to undergo amputation.


Assuntos
Amputação/métodos , Neoplasias Ósseas/cirurgia , Salvamento de Membro/métodos , Osteossarcoma/cirurgia , Extremidade Superior/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Osteossarcoma/patologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
6.
Cancer Metastasis Rev ; 38(4): 709-722, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31807972

RESUMO

The multi-disciplinary approach involving imaging, multi-agent chemotherapy, meticulous surgical procedures, and careful postoperative care has facilitated an increase in the use of limb-sparing surgery for pediatric osteosarcoma. Osteosarcoma usually occurs around the metaphysis of the distal femur or proximal tibia and needs wide excision with the adjacent joint and replacement by a megaprosthesis. The recent advancement in imaging modalities and surgical techniques supports joint-preservation surgery (JPS), involving the preservation of the adjacent epiphysis, for select patients following careful assessment of the tumor margins and precise tumor excision. An advantage of this surgery is that it maintains the adjacent joint and preserves the growth of the residual epiphysis, which provides excellent limb function. Various reconstruction options are available, including allograft, tumor-devitalized autograft, vascularized fibula graft, distraction osteogenesis, and custom-made implants. However, several complications are inevitable with these options, such as loosening, non-union at the host-graft junction, infection, fracture, implant loosening, breakage, deformity, limb-length discrepancy related to the reconstruction methods, or patient growth in pediatric osteosarcoma. Surgeons should fully understand the advantages and disadvantages of this procedure. In this review, we discuss the concept of JPS, types of reconstruction methods, and current treatment outcomes. It is our opinion that the further analysis by multi-institutional setting is necessary to clarify long-term outcomes and establish global guidelines on the indications and surgical procedure for JPS.


Assuntos
Neoplasias Ósseas/cirurgia , Articulação do Joelho/cirurgia , Osteossarcoma/cirurgia , Aloenxertos , Neoplasias Ósseas/patologia , Criança , Humanos , Articulação do Joelho/patologia , Prótese do Joelho , Salvamento de Membro/métodos , Osteossarcoma/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos
7.
Orthopedics ; 42(6): e514-e520, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31587080

RESUMO

Limb salvage is the treatment of choice for malignant shoulder girdle tumors; however, there is a paucity of data examining the long-term outcome. The authors have previously reported on a cohort of patients at short- and mid-term follow-up. The purpose of this study was to report the long-term outcome of shoulder reconstruction in terms of oncological and functional outcome. The authors reviewed 53 patients who underwent a limb salvage procedure for treatment of a tumor of the shoulder girdle. At a mean of 28 years following the resection, 76% of surviving patients were contacted and administered functional outcome scores using the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage (TESS). The 20-year survival and recurrence-free survival were 79% and 80%, respectively. Likewise, the 20-year revision survival was 75%, with a limb salvage rate of 94%. At last follow-up, the mean MSTS rating and TESS score were 75% and 85%, respectively, with 9 patients having improvement in their MSTS rating from the previous findings. Limb salvage following resection of shoulder girdle tumor resulted in acceptable means of oncological outcome and function. Some patients continued to experience improvements in functional outcome even at late (>20 years) follow-up. [Orthopedics. 2019; 42(6):e514-e520.].


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Salvamento de Membro/métodos , Recidiva Local de Neoplasia/cirurgia , Osteossarcoma/cirurgia , Ombro/cirurgia , Adolescente , Adulto , Idoso , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Criança , Pré-Escolar , Condrossarcoma/mortalidade , Condrossarcoma/patologia , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ombro/patologia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
8.
J Bone Joint Surg Am ; 101(18): e94, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31567809

RESUMO

Road traffic accident-related severely injured extremities account for the majority of disabilities in young people in China. Limb-salvage concepts and techniques vary greatly from physician to physician and from district to district in China. Current severity-scoring systems for lower-extremity injuries lack sensitivity and cannot be used as the sole criterion by which amputation decisions are made. China lacks a national database of mangled lower extremities, which is a priority for both limb-salvage protocols and scoring system development.


Assuntos
Traumatismos da Perna/diagnóstico , Traumatismos da Perna/cirurgia , Salvamento de Membro/normas , Acidentes de Trânsito , Amputação , China , Protocolos Clínicos , Humanos , Salvamento de Membro/métodos , Índices de Gravidade do Trauma
9.
Plast Reconstr Surg ; 144(4): 982-987, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31568316

RESUMO

BACKGROUND: Gustilo type IIIC open tibia fractures are characterized by an ischemic limb requiring immediate arterial repair. In this patient population, the decision between primary amputation and limb salvage can be challenging. This study aims to evaluate the reconstructive outcomes of patients with Gustilo type IIIC injuries. METHODS: A single-center retrospective review of 806 lower extremity free flaps from 1976 to 2016 was performed. Flap loss and salvage rates for patients with Gustilo type IIIC injuries were determined. To determine the utility of performing salvage in this group, outcomes of the IIIC reconstructions were compared to those of similar patients with Gustilo I type IIB injuries with only a single patent vessel. RESULTS: A total of 32 patients with Gustilo type IIIC injuries underwent reconstruction after traumatic injury. Ten patients (31.3 percent) experienced a perioperative complication, including seven unplanned returns to the operating room (21.9 percent), three partial flap losses (9.4 percent), and five complete flap losses (15.6 percent). When type IIIC injuries were compared with single-vessel Gustilo type IIIB injuries, no statistically significant differences were noted with respect to major perioperative complications (p = 0.527), unplanned return to the operating room (p = 0.06), partial flap loss (p = 0.209), complete flap loss (p = 0.596), or salvage rate (p = 0.368). Although this result was not statistically significant, Gustilo type IIIC injuries trended toward lower take-back rates and higher salvage rates compared with single-vessel Gustilo type IIIB injuries. CONCLUSION: Patients with Gustilo type IIIC open tibia fractures should be considered candidates for limb salvage, as flap loss and reconstruction of these injuries are comparable to those of the routinely reconstructed single-vessel runoff type IIIB injuries. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Retalhos de Tecido Biológico , Isquemia/cirurgia , Traumatismos da Perna/cirurgia , Perna (Membro)/irrigação sanguínea , Perna (Membro)/cirurgia , Salvamento de Membro/métodos , Adulto , Feminino , Fraturas Expostas/classificação , Fraturas Expostas/complicações , Humanos , Isquemia/etiologia , Traumatismos da Perna/classificação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Fraturas da Tíbia/classificação , Fraturas da Tíbia/complicações , Resultado do Tratamento , Adulto Jovem
10.
Bone Joint J ; 101-B(9): 1144-1150, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474137

RESUMO

AIMS: The aim of this study was to report the results of custom-made endoprostheses with extracortical plates plus or minus a short, intramedullary stem aimed at preserving the physis after resection of bone sarcomas in children. PATIENTS AND METHODS: Between 2007 and 2017, 18 children aged less than 16 years old who underwent resection of bone sarcomas, leaving ≤ 5 cm of bone from the physis, and reconstruction with a custom-made endoprosthesis were reviewed. Median follow-up was 67 months (interquartile range 45 to 91). The tumours were located in the femur in 11 patients, proximal humerus in six, and proximal tibia in one. RESULTS: The five-year overall survival rate was 78%. No patient developed local recurrence. The five-year implant survival rate was 79%. In all, 11 patients (61%) developed a complication. Seven patients (39%) required further surgery to treat the complications. Implant failures occurred in three patients (17%) including one patient with aseptic loosening and two patients with implant or periprosthetic fracture. The preserved physis continued to grow at mean 3.3 cm (0 to 14). The mean Musculoskeletal Society score was 88% (67% to 97%). CONCLUSION: Custom-made endoprostheses that aim to preserve the physis are a safe and effective option for preserving physeal growth, limb length, and joint function with an acceptable rate of complications. Cite this article: Bone Joint J 2019;101-B:1144-1150.


Assuntos
Neoplasias Ósseas/cirurgia , Lâmina de Crescimento/cirurgia , Osteossarcoma/cirurgia , Próteses e Implantes , Adolescente , Criança , Feminino , Fêmur/cirurgia , Fixação Intramedular de Fraturas , Humanos , Úmero/cirurgia , Salvamento de Membro/métodos , Masculino , Desenho de Prótese , Falha de Prótese , Implantação de Prótese/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Recuperação de Função Fisiológica , Reoperação , Tíbia/cirurgia
11.
Bone Joint J ; 101-B(9): 1151-1159, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474143

RESUMO

AIMS: We analyzed the long-term outcomes of patients observed over ten years after resection en bloc and reconstruction with extracorporeal irradiated autografts. PATIENTS AND METHODS: This retrospective study included 27 patients who underwent resection en bloc and reimplantation of an extracorporeal irradiated autograft. The mean patient age and follow-up period were 31.7 years (9 to 59) and 16.6 years (10.3 to 24.3), respectively. The most common diagnosis was osteosarcoma (n = 10), followed by chondrosarcoma (n = 6). The femur (n = 13) was the most frequently involved site, followed by the tibia (n = 7). There were inlay grafts in five patients, intercalary grafts in 15 patients, and osteoarticular grafts in seven patients. Functional outcome was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. RESULTS: There were no recurrences in the irradiated autograft and the autograft survived in 24 patients (88.9%). Major complications included nonunion (n = 9), subchondral bone collapse (n = 4), and deep infection (n = 4). Although 34 revision procedures were performed, 25 (73.5%) and four (11.8%) of these were performed less than five years and ten years after the initial surgery, respectively. The mean MSTS score at the last follow-up was 84.3% (33% to 100%). CONCLUSION: Considering long-term outcomes, extracorporeal irradiated autograft is an effective method of reconstruction for malignant musculoskeletal tumours Cite this article: Bone Joint J 2019;101-B:1151-1159.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/cirurgia , Osso e Ossos/cirurgia , Salvamento de Membro/métodos , Reimplante , Transplante Autólogo/métodos , Adolescente , Adulto , Autoenxertos/efeitos da radiação , Osso e Ossos/efeitos da radiação , Criança , Seguimentos , Sobrevivência de Enxerto , Humanos , Pessoa de Meia-Idade , Radioterapia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Transplante Autólogo/efeitos adversos , Adulto Jovem
12.
BMC Musculoskelet Disord ; 20(1): 367, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399083

RESUMO

BACKGROUND: Reconstruction for large bone defect of distal tibia after wide resection of tumor is difficult, and the best option remains controversial. This study presents a novel "double-strut" fibula ankle arthrodesis for this issue. METHODS: Nine patients with malignant or aggressive tumors of distal tibia underwent novel "double-strut" fibula ankle arthrodesis after wide tumor resection were retrospectively reviewed. We assessed the bone union time, complications and oncology outcome clinically and radiographically. The Musculoskeletal Tumor Society (MSTS) score and the Foot and Ankle Outcome Score (FAOS) were used to evaluate the functional outcome. RESULTS: The average followup period was 53 ± 46 months. There was no deep infection or graft fracture observed in this series. Internal fixation loosening was found in one case. In these patients, eight achieved union at both proximal and distal junctions, while one achieved union only distally. The mean union time of the proximal junctions and distal junctions was 10.5 ± 1.6 months and 8.7 ± 2.3 months, respectively. The mean postoperative MSTS score was 83% ± 8%. The subscales of FAOS indicating the most problem was Sport and Recreation Function with a mean score of 18 ± 11. At the final follow-up, one of them (1/9, 11%) experienced local recurrence in soft tissue and received another resection surgery, and four (4/9, 44%) patients developed lung metastases. CONCLUSIONS: For large bone defect of distal tibia, this novel "double-strut" fibula reconstruction can be a viable alternative, which is capable of achieving durable ankle fusion and functional salvaged limb with low rate of complications.


Assuntos
Artrodese/métodos , Neoplasias Ósseas/cirurgia , Transplante Ósseo/métodos , Fíbula/transplante , Salvamento de Membro/métodos , Osteossarcoma/cirurgia , Adolescente , Adulto , Articulação do Tornozelo/cirurgia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Estudos Retrospectivos , Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
13.
J Bone Joint Surg Am ; 101(16): 1470-1478, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436655

RESUMO

BACKGROUND: Severe upper-extremity injuries account for almost one-half of all extremity trauma in recent conflicts in the Global War on Terror. Few long-term outcomes studies address severe combat-related upper-extremity injuries. This study's objective was to describe long-term functional outcomes of amputation compared with those of limb salvage in Global War on Terror veterans who sustained severe upper-extremity injuries. Limb salvage was hypothesized to result in better arm and hand function scores, overall functional status, and quality of life, with similar pain interference. METHODS: This retrospective cohort study utilized data from the Military Extremity Trauma Amputation/Limb Salvage (METALS) study for a subset of 155 individuals who sustained major upper-extremity injuries treated with amputation or limb salvage. Participants were interviewed by telephone 40 months after injury, assessing social support, personal habits, and patient-reported outcome instruments for function, activity, depression, pain, and posttraumatic stress. Outcomes were evaluated for participants with severe upper-extremity injuries and were compared with participants with concomitant severe, lower-extremity injury. The analysis of outcomes comparing limb salvage with amputation was restricted to the 137 participants with a unilateral upper-extremity injury because of the small number of patients with bilateral upper-extremity injuries (n = 18). RESULTS: Overall, participants with upper-extremity injuries reported moderate to high levels of physical and psychosocial disability. Short Musculoskeletal Function Assessment (SMFA) scores were high across domains; 19.4% screened positive for posttraumatic stress disorder (PTSD), and 12.3% were positive for depression. Nonetheless, 63.6% of participants were working, were on active duty, or were attending school, and 38.7% of participants were involved in vigorous recreational activities. No significant differences in outcomes were observed between patients who underwent limb salvage and those who underwent amputation. CONCLUSIONS: Severe, combat-related upper-extremity injuries result in diminished self-reported function and psychosocial health. Our results suggest that long-term outcomes are equivalent for those treated with amputation or limb salvage. Addressing or preventing PTSD, depression, chronic pain, and associated health habits may result in less disability burden in this population. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Amputação/métodos , Traumatismos do Braço/cirurgia , Salvamento de Membro/métodos , Militares/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , Amputação/psicologia , Traumatismos do Braço/diagnóstico , Traumatismos do Braço/reabilitação , Membros Artificiais , Estudos de Coortes , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Guerra do Iraque 2003-2011 , Salvamento de Membro/psicologia , Masculino , Militares/psicologia , Medidas de Resultados Relatados pelo Paciente , Implantação de Prótese/métodos , Estudos Retrospectivos , Medição de Risco , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
Yonsei Med J ; 60(9): 882-886, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31433587

RESUMO

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.


Assuntos
Ameloblastoma/cirurgia , Neoplasias Ósseas/cirurgia , Salvamento de Membro/métodos , Impressão Tridimensional , Desenho de Prótese/métodos , Implantação de Prótese , Tíbia/patologia , Tíbia/cirurgia , Adulto , Ameloblastoma/patologia , Neoplasias Ósseas/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Próteses e Implantes , Resultado do Tratamento
15.
J Bone Joint Surg Am ; 101(15): e74, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393431

RESUMO

BACKGROUND: Salvaging the forearm is a major challenge in cases of massive bone loss from injuries in which the extremity is severely mangled or following bone resection secondary to pathological tissue excision. The purpose of this study was to evaluate the role of one-bone forearm (OBF) reconstruction as a salvage option in these difficult situations. METHODS: A total of 38 patients with forearm segmental bone loss (acute and chronic) treated between 1995 and 2014 were included (range of follow-up, 2 to 20 years). Sixteen of the patients, 8 with avulsion amputations and 8 with severely mangled extremities, were managed in the emergency department because they required immediate replantation and revascularization, respectively. In the chronic setting, bone loss was due to infection with nonunion in 16 patients, tumor of the radius in 2 patients, and pseudarthrosis of the forearm in 4 patients. The surgical technique included conversion to OBF by achieving union between the distal part of the radius and the proximal part of the ulna in the majority of cases, with distal radioulnar joint (DRUJ) fusion in 4 cases, and ulna to carpals in 5 cases. Direct bone contact was achieved in 16 patients, a free vascularized fibular graft was used to bridge the bone gap in 10 patients, and 12 patients required iliac crest bone-grafting. RESULTS: The mean patient age was 35.5 years (range, 6 to 87 years); there were 23 male and 15 female patients. Among those who underwent OBF for acute injuries, the mean time to union was 7.3 months; 14 patients had complete union, and 2 patients had infection with nonunion requiring secondary procedures. As assessed using the criteria of Chen, 10 patients had a grade-I functional outcome, 3 patients had a grade-II outcome, and 3 patients had a grade-III outcome. In the elective group of 22 patients, the average time to union was 7.1 months. Nonunion was reported for 2 patients. On the basis of the Peterson scoring system, the outcome was excellent for 12 patients, good for 6 patients, fair for 2 patients, and poor for 2 patients. CONCLUSIONS: OBF reconstruction is a viable surgical treatment alternative. It is a demanding reconstruction but functions better and is cosmetically more appealing than a forearm amputation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Lesões por Esmagamento/cirurgia , Traumatismos do Antebraço/cirurgia , Salvamento de Membro/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reimplante/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação Traumática/cirurgia , Artrodese/métodos , Transplante Ósseo/métodos , Criança , Estudos de Coortes , Avaliação da Deficiência , Feminino , Traumatismos do Antebraço/diagnóstico , Consolidação da Fratura/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)/lesões , Rádio (Anatomia)/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Ulna/lesões , Ulna/cirurgia , Cicatrização/fisiologia , Adulto Jovem
16.
Asia Pac J Clin Oncol ; 15(6): 371-376, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31321885

RESUMO

AIM: Intensity-modulated radiotherapy (IMRT) has demonstrated improved local control in extremity soft tissue sarcoma (STS) after limb-sparing surgery compared with three-dimensional conformal radiation therapy. Our purpose was to evaluate sliding-window IMRT (SW-IMRT) and volumetric arc therapy (VMAT) in planning target volume (PTV) coverage and dose to organs-at-risk (OAR). METHODS: Sixteen patients undergoing postoperative RT for lower extremity STS were included. For each patient, one VMAT plan and one SW-IMRT plan were proposed. Both were evaluated using cumulative dose-volume histogram data for OAR and PTVs. Prescribed dose was 66 Gy (2 Gy/fraction) to PTV1 and 56 Gy (1.69 Gy/fraction) to PTV2. OARs contoured were femur, neurovascular bundle, minimum tissue corridor, normal tissue outside PTV2, joint and genitalia. T-Student test was performed. RESULTS: Eleven male (69%) and five female patients (31%) were analyzed. Mean age was 60 years. Both techniques showed optimal target coverage, conformity index (CI) and homogeneity index (HI). VMAT PTV2 CI was 1.13 (mean) ± 0.08 (standard deviation) versus 1.19 ± 0.10 SW-IMRT PTV2 CI (P < 0.05). VMAT PTV1 HI was 0.09 ± 0.01 versus 0.08 ± 0.01 SW-IMRT PTV1 HI (P < 0.05). Regarding OARs, VMAT delivered lower dose to femur, genitalia, normal tissue outside PTV2 and joints. SW-IMRT spared tissue corridor mean dose (10.4 Gy ± 6.8 Gy) versus (14.7 ± 6.5 Gy) VMAT (P < 0.05). CONCLUSIONS: Both techniques achieved great conformity, homogeneity and coverage of PTV. VMAT produced lower dose to OARS and SW-IMRT was superior in sparing dose to normal-tissue-corridor, which could reduce risk of lymphedema.


Assuntos
Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada/métodos , Sarcoma/radioterapia , Neoplasias de Tecidos Moles/radioterapia , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Dosagem Radioterapêutica , Radioterapia Adjuvante/métodos , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Coxa da Perna
17.
Orthopedics ; 42(5): 260-266, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31355903

RESUMO

High-energy open fractures of the tibia are frequently associated with tissue loss, wound contamination, and compromised vascularity that often result in amputation. The management of these severe injuries remains a challenge for orthopedic reconstructive surgeons. Studies have compared the timing of soft tissue coverage of Gustilo type IIIB open tibia fractures with associated outcomes such as rate of deep infection, primary union, length of hospitalization, flap failure, and eventual secondary amputation. These studies often highlight better outcomes with specific time domains that are not always attainable at a large tertiary hospital with multi-system trauma patients. Many studies do not account for delayed patient transfers after initial open fracture management elsewhere. This retrospective analysis of the limb salvage outcomes included 140 consecutive patients with Gustilo type IIIB open tibia fractures who presented to the authors' level I trauma center between 2001 and 2014. The authors included patients who required delayed coverage or who were transferred from outside institutions. The majority (77%) were male, and the mean age was 39.4 years. Motor vehicle accidents were the most common cause of injury, and 83% of patients obtained full weight-bearing status with successful limb salvage. Twenty patients had a secondary amputation, with the cause being refractory osteomyelitis in 52%. This study provides guidance on treating a heterogeneous patient population with severe open tibia fractures typically seen in a large tertiary hospital orthopedic trauma service. [Orthopedics. 2019; 42(5):260-266.].


Assuntos
Fraturas Expostas/cirurgia , Salvamento de Membro/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação , Criança , Feminino , Fraturas Expostas/complicações , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/transplante , Osteomielite/etiologia , Osteomielite/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Estudos Retrospectivos , Retalhos Cirúrgicos , Fraturas da Tíbia/complicações , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
Bone Joint J ; 101-B(6): 724-731, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31154850

RESUMO

AIMS: Aseptic loosening is a major cause of failure in cemented endoprosthetic reconstructions. This paper presents the long-term outcomes of a custom-designed cross-pin fixation construct designed to minimize rotational stress and subsequent aseptic loosening in selected patients. The paper will also examine the long-term survivorship and modes of failure when using this technique. PATIENTS AND METHODS: A review of 658 consecutive, prospectively collected cemented endoprosthetic reconstructions for oncological diagnoses at a single centre between 1980 and 2017 was performed. A total of 51 patients were identified with 56 endoprosthetic implants with cross-pin fixation, 21 of which were implanted following primary resection of tumour. Locations included distal femoral (n = 36), proximal femoral (n = 7), intercalary (n = 6), proximal humeral (n = 3), proximal tibial (n = 3), and distal humeral (n = 1). RESULTS: The median follow-up was 132 months (interquartile range (IQR) 44 to 189). In all, 20 stems required revision: eight for infection, five for structural failure, five for aseptic loosening, and two for tumour progression. Mechanical survivorship at five, ten, and 15 years was 84%, 78%, and 78%, respectively. Mechanical failure rate varied by location, with no mechanical failures of proximal femoral constructs and distal femoral survivorship of 82%, 77%, and 77% at five, ten, and 15 years. The survivorship of primary constructs at five years was 74%, with no failure after 40 months, while the survivorship for revision constructs was 89%, 80%, and 80% at five, ten, and 15 years. CONCLUSION: The rate of mechanical survivorship in our series is similar to those reported for other methods of reconstruction for short diaphyseal segments, such as compressive osseointegration. The mechanical failure rate differed by location, while there was no substantial difference in long-term survival between primary and revision reconstructions. Overall, custom cross-pin fixation is a viable option for endoprosthetic reconstruction of short metaphyseal segments with an acceptable rate of mechanical failure. Cite this article: Bone Joint J 2019;101-B:724-731.


Assuntos
Pinos Ortopédicos , Neoplasias Ósseas/cirurgia , Salvamento de Membro/métodos , Próteses e Implantes , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Feminino , Neoplasias Femorais/diagnóstico por imagem , Neoplasias Femorais/patologia , Neoplasias Femorais/cirurgia , Seguimentos , Humanos , Úmero/diagnóstico por imagem , Úmero/patologia , Úmero/cirurgia , Masculino , Estudos Prospectivos , Falha de Prótese , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tíbia/cirurgia , Resultado do Tratamento
20.
BMC Surg ; 19(1): 57, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146705

RESUMO

BACKGROUND: However, the application of limb salvage with joint preservation is controversial. The purpose of this study is to propose a selection strategy of joint-sparing operative procedures for humeral malignancies based on tumor origin, site and bone strength. METHODS: The medical data of 28 patients with humeral malignancies treated at our institute from January 2010 to December 2016 were analyzed retrospectively. The patients had a median age of 51 years (range, 8-82 years). Bone strength scoring system was utilized to evaluated bone strength of the tumor. Four joint-sparing surgical methods were performed on selected patients. Evaluation of limb function was based on the Musculoskeletal Tumor Society scoring system. Two-sample t-test was used to compare patient group data such as bone strength score and postoperative Musculoskeletal Tumor Society score. RESULTS: The mean follow-up period for the 7 patients with primary malignancies was 45 months (range, 15-66 months). One patient died due to recurrence and lung metastasis, while the remaining 6 patients (6/7, 85.7%) survived without recurrence. For the 21 patients with metastases, 5 survived with tumors, with an average survival time of 25.8 months (range, 9-48 months). The rest died from progression of the primary tumors. The mean bone strength score for the biological reconstruction group and non-biological reconstruction group was respectively 9.7 ± 1.3 and 12.9 ± 1.2. A significant difference between the 2 groups (p < 0.05) was found. Mean postoperative Musculoskeletal Tumor Society score was respectively 27.2 ± 1.8 and 26.1 ± 1.7 for the 2 groups. There was no significant difference between the 2 groups (p > 0.05). Non-oncological complications included fracture (1), aseptic loosening (1) and radial nerve injury (1). CONCLUSIONS: Alcohol devitalized autograft replantation is applicable for diaphyseal humeral primary malignancies, with a good response to chemotherapy and a low bone strength score (≤10). In situ microwave ablation is suitable for diaphyseal and (or) metaphyseal low-grade malignant bone tumors or metastases with a low bone strength score (≤10). Intercalary prosthetic reconstruction is preferred for diaphyseal metastases with a high bone strength score (> 10).


Assuntos
Neoplasias Ósseas/cirurgia , Úmero/cirurgia , Salvamento de Membro/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Diáfises/cirurgia , Extremidades , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA