Page 220 - Reconstructive Techniques in Musculoskeletal Tumor Surgery

Chapter 11
support the idea that this reduces the risk of deep infection. It has, however, been shown that omentoplasty can be used to successfully ll a large cavity and cover an infected structure (bronchopleural stula)93.
Filling the dead space with large amounts of antibiotic-loaded bone cement is another technique to reduce the risk of deep infection39. On the other hand, the exothermic reaction of polymethylmethacrylate (PMMA) bone cement may cause further damage to surrounding soft tissues94. Furthermore, multi- resistant microorganisms may evolve. Alternatives for delivering large amounts of antibiotics locally include Garacol® (EUSA Pharma, Hemel Hampstead, United Kingdom) and Septopal® (Zimmer Biomet, Warsaw, IN, United States), although there is no evidence to support the use of these agents in large tumor defects. Future research should be directed at developing and evaluating the e cacy of bactericidal materials that can be used to ll the dead space after tumor resection.
Part II: Management of Extremity Bone Tumors
Primary bone tumors of the appendicular skeleton most commonly a ect the epimetaphyseal regions of the distal femur, proximal tibia, proximal humerus and proximal femur95, 96. Many studies therefore focused on reconstructions of the knee, hip, and shoulder. Three techniques can be used to reconstruct a functional joint following articular tumor resection: transplantation of an osteoarticular allograft, implantation of an endoprosthesis, or a combination of the two (allograft- prosthetic composite, APC)97-100. Although these techniques have greatly improved possibilities and functional outcomes for sarcoma patients, joint replacements for bone tumors are still associated with relatively high complication and revision rates57. Intercalary reconstructions salvage the native joint, lack moving components, are easier to perform, and are generally associated with a lower risk of late mechanical failure33, 101. Therefore, we prefer these joint-sparing resections whenever oncologically safe. In an attempt to further improve mechanical results of intercalary reconstructions, our center pioneered with hemicortical resection of tumors with limited cortical and intramedullary involvement102.
Below, complications and failure modes of di erent biological and endoprosthetic techniques will be discussed, based on the Henderson classi cation9. Furthermore, comments will be made on controversies in surgical strategies for reconstructions after lower-extremity bone tumor resection.
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