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Segmental resection and replantation have a role for selected advanced sarcomas in the upper limb

 Soo Bong Hahn  ;  Yun Rak Choi  ;  Ho Jung Kang  ;  Kyoo Ho Shin 
 Clinical Orthopaedics and Related Research, Vol.467(11) : 2918-2924, 2009 
Journal Title
 Clinical Orthopaedics and Related Research 
Issue Date
Adolescent ; Adult ; Bone Neoplasms/pathology ; Bone Neoplasms/surgery* ; Combined Modality Therapy ; Female ; Follow-Up Studies ; Humans ; Limb Salvage/methods* ; Male ; Neoplasm Invasiveness/pathology* ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/pathology ; Osteosarcoma/pathology ; Osteosarcoma/surgery* ; Patient Selection ; Reconstructive Surgical Procedures/methods ; Recovery of Function ; Replantation/methods* ; Retrospective Studies ; Risk Assessment ; Sampling Studies ; Time Factors ; Treatment Outcome ; Upper Extremity ; Wound Healing/physiology ; Young Adult
Although limb salvage surgery for primary sarcoma of the upper limb is a standard procedure, it often is technically challenging. We asked whether segmental resection and replantation would provide (1) local control and long-term survival and (2) useful limb function in patients who had advanced primary malignant and aggressive tumors of the upper limbs. We retrospectively reviewed six patients treated with this procedure when a wide resection around the tumor could not be achieved with other limb-salvage procedures. Diagnoses included osteosarcoma (two), Ewing's sarcoma (one), leiomyosarcoma (one), and giant cell tumor (two). Four patients had displaced pathologic fractures. Minimum followup was 40 months (mean, 164 months; range, 40-214 months). All but one patient remained disease-free; the patient with Ewing's sarcoma died from the disease 40 months after surgery. The average functional score at last followup was 20 points. The mean grasping and pinching power of the operative hand were 66% and 72% of the contralateral side, respectively. Two patients had complications: one had wound dehiscence that subsequently healed and one had radial nerve palsy that recovered spontaneously by 3 months. Segmental resection and replantation may have a role in selected cases for treatment of advanced primary sarcoma or aggressive giant cell tumor of the upper limb as partial limb salvage. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kang, Ho Jung(강호정) ORCID logo https://orcid.org/0000-0003-0273-1264
Shin, Kyoo Ho(신규호)
Choi, Yun Rak(최윤락)
Hahn, Soo Bong(한수봉)
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