Multiplanar osteotomy with limited wide margins: a tissue preserving surgical technique for high-grade bone sarcomas.
BACKGROUND
Limb-salvage surgery has been used during the last several decades to treat patients with high-grade bone sarcomas. In the short- and intermediate-term these surgeries have been associated with relatively good function and low revision rates. However, long-term studies show a high rate of soft tissue, implant, and bone-related complications. Multiplanar osteotomy with limited wide margins uses angled bone cuts to resect bone tumors with the goal of complete tumor removal while sparing host tissue although its impact on local recurrence is not known.


OBJECTIVE
We determined whether multiplanar osteotomy was associated with local recurrences, reconstruction failures, and allograft nonunions.


METHODS
We retrospectively reviewed the charts of six patients. Four patients had an osteosarcoma, one had a Ewing's sarcoma, and one had a chondrosarcoma. Patient and treatment factors such as age, diagnosis, percent of tumor necrosis (if applicable), margin status, and time to allograft union were recorded. In all patients, reconstruction was performed with an intercalary allograft cut to fit the residual defect. The minimum followup was 25 months (average, 39 months; range, 24-66 months).


RESULTS
No patient experienced a local recurrence or metastasis, and all patients were alive and disease-free at the most recent followup. All allografts healed during the study period.


CONCLUSIONS
With careful patient selection, the multiplanar osteotomy resection technique may be considered an option for treating patients with high-grade bone sarcomas, and, when compared with traditional surgical techniques, may lead to improved healing and function of the involved extremity.


METHODS
Level IV, therapeutic study. See the guidelines online for a complete description of levels of evidence.
Avedian
Raffi S
RS
Department of Orthopaedic Surgery, Stanford University Medical Center, 450 Broadway St. MC 6342, Redwood City, CA 94063, USA. ravedian@stanford.edu
Haydon
Rex C
RC
Peabody
Terrance D
TD
D000293:Adolescent; D001859:Bone Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016025:Bone Transplantation / Q000009:adverse effects; D002648:Child; D002813:Chondrosarcoma / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005266:Femoral Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D023821:Limb Salvage; D008279:Magnetic Resonance Imaging; D008297:Male; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016348:Osseointegration; D012516:Osteosarcoma / Q000601:surgery; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D018579:Patient Selection; D011859:Radiography; D012189:Retrospective Studies; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D012512:Sarcoma, Ewing / Q000601:surgery; D013977:Tibia / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014945:Wound Healing; D055815:Young Adult