Page 14 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 1
If applicable for the type of tumor, patients are rst treated with neoadjuvant chemotherapy and/or radiotherapy. The subsequent limb-salvaging surgical procedure consists of three phases: (1) tumor resection, usually with the aim to obtain clear surgical margins, (2) skeletal reconstruction, and (3) soft tissue reconstruction25, 26. The techniques of reconstruction vary and are dictated by surgeon preferences, tumor localization, extent of the defect, and the availability of implants. A large variety of techniques are employed at present, each having its speci c advantages and disadvantages; unfortunately, these large reconstructions do not come without complications. Many techniques have not been reviewed properly and therefore, it is di cult to make an evidence-based decision when having to choose the optimal reconstructive technique for the individual patient. Reasons for the paucity of solid evidence include the low incidence of primary musculoskeletal tumors, the heterogeneity in presentation, and signi cant loss to follow-up due to mortality, as a result of metastases.
The aim of this thesis is to evaluate the outcomes of di erent reconstructive techniques in treatment of pelvic and extremity bone tumors, to identify risk factors for impaired clinical outcome, and ultimately to improve outcomes for patients with musculoskeletal tumors.
Part I: Management of Pelvic Bone Tumors
Pelvic bone tumors include primary malignancies and metastatic tumors27. The most common primary tumors of pelvic bone are central and peripheral chondrosarcomas, myeloma, Ewing’s sarcoma and, to a lesser extent, osteosarcoma1, 14, 15, 28-30. The traditional treatment for malignant tumors of pelvic bone is hindquarter amputation21, 31-33. The term hindquarter amputation (or external hemipelvectomy) is used to designate the complete removal of the lower extremity, the corresponding buttock, and the entire innominate bone in one stage34, 35 ( gure 4). In 1959, Gordon-Taylor reported on his experiences with hindquarter amputations in a series of 41 patients36. He noted perioperative mortality in 25 patients (61%), and described the procedure as “one of the most colossal mutilations practiced on the human frame”.
Internal hemipelvectomy, on the other hand, does not sacri ce the una ected lower extremity (i.e. the leg on the a ected side remains intact, although functionality may be impaired signi cantly). Internal hemipelvectomies were rst performed for treatment of tumors of the ilium and pubis, and were later presented as an alternative treatment for tumors of the (peri-)acetabulum37, 38. In
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