Page 219 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

has been one of the most discussed techniques85-87. Silver coating of various medical materials, such as cardiac and urinary catheters, previously proved to reduce the risk of infection85. Studies demonstrated that silver coating of MUTARS endoprostheses (implantcast, Buxtehude, Germany) e ectively reduced the risk of infection in a rabbit model, and that the use of silver coating is free of side- e ects85, 86. Furthermore, two retrospective clinical studies showed that silver coating may increase the likelihood of successful revision surgery in case of endoprosthetic infection, and of being able to retain an implant in case it gets infected87, 88. It should be noted, however, that the number of patients included in these studies were limited, while other studies were not able to detect a signi cant di erence40, 58. Furthermore, comparative studies between coated and uncoated implants are lacking and thus, there is currently no solid evidence to support the idea that silver coating reduces the risk of infection of primary endoprosthetic reconstructions for bone tumors. One may therefore question whether coated implants should be used routinely. A cost-bene t analysis will have to be conducted to answer this question.
More recently, researchers from Japan reported excellent results for iodine coating of titanium endoprostheses for preventing and treating periprosthetic infection89, 90. Future studies are needed to assess the bene cial e ect and potential complications of the use of di erent coatings in endoprosthetic reconstructions84. This should include analysis of a potential e ect on implant xation. Meanwhile, patients with coated implants should be followed on a regular basis and surgeons should be alert for side e ects, such as clinical evidence of argyria in patients with silver coated implants84.
The use of myocutaneous aps, to cover implants with well-vascularized soft tissue and to eliminate dead space, also gained attention during recent years. Some centers use a rectus abdominis myocutaneous ap as a standard of treatment for patients with a pelvic reconstruction68, 91. These techniques however necessitate large contralateral dissection, usually take long and often require extensive blood transfusion91. Regardless of the use of such extensive aps, the risk of wound problems remained high in a study on pelvic reconstructions68. In addition, the use of extensive aps undermines the integrity of the abdominal wall and has a risk of herniation92. Therefore, we are of the opinion that surgeons should be hesitant to perform a myocutaneous ap rotation during the primary procedure in treatment of pelvic tumors. Omentoplasty is an alternative technique that may be used to cover pelvic reconstructions, although there are currently no studies to
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