Page 15 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

1978, Enneking and Dunham proposed a classi cation system for pelvic tumor 1 resections: type 1, involving the iliac wing; type 2, the periacetabular region; type
3, the pubic rami; and type 4, the sacrum ( gure 5)39, 40. Isolated type 1 or type 3
resections are relatively easy and reconstruction is generally not needed because
the acetabulum and weight-bearing axis are preserved38. Type 2 resections however require reconstruction in order to restore force transmission along anatomic axes, and therefore pose unique surgical challenges27, 41.
Figure 4: Photograph of specimen immediately after removal by hindquarter amputation (from Gordon Gordon-Taylor and Philip Wiles, Interinnomino-abdominal [hind-quarter] amputation [The British Journal of Surgery: volume XXII – No. 88, 1935]).
Although most patients with a periacetabular bone tumor can at present be treated by internal hemipelvectomy, these procedures are considered some of the most challenging operations in musculoskeletal oncology21, 41. First, pelvic neoplasms often grow to immense proportions before diagnosis ( gure 6). Second, the pelvic anatomy is complex, and tumors frequently grow close to vital neurovascular structures. As a result, it is often di cult to obtain clear resection margins41, 42. Treatment of pelvic metastases is generally less complicated because the procedure is usually intralesional and therefore requires less bone and soft tissue resection38. Third, reconstruction is di cult because of high loading forces, limited bone stock, and large soft-tissue defects43-46. This re ects an important dilemma in treatment of these tumors: the decision to obtain adequate surgical margins, while salvaging enough bone to preserve longevity and function of the a ected limb47.
General introduction
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