CORR Insights^®: Is Limb Salvage With Microwave-induced Hyperthermia Better Than Amputation for Osteosarcoma of the Distal Tibia?

Excerpt

Osteosarcomas at the distal tibia pose considerable challenges to limb salvage surgery. Any soft-tissue mass in the distal leg lies in close proximity to the important tendons and neuromuscular structures narrowing the sought-after wide margin for limb salvage. Though osteosarcomas at the distal tibia are rare (< 4% of all osteosarcomas), several forms of reconstruction have been described, and there are problems with each. Prosthetic reconstruction is associated with frequent complications [1, 9, 14], and allografts have high rates of nonunions and delayed unions [2, 13]. Vascularized fibular autografts (either pedicled or free) are technically demanding, lengthy procedures associated with a protracted convalescence during which weight bearing is limited [4, 8, 15, 16]. Nonvascularized fibular grafts carry the risk of stress fracture, particularly with longer segments and also take time to hypertrophy. Bone transport is satisfactory for shorter lengths but also risks junctional nonunions [8]. External fixation wires and pins can be a problem for those on chemotherapy. These complications can undermine the benefits associated with limb salvage, which has been shown to provide superior function compared to amputation [13], the historical surgical treatment for osteosarcoma. …