title: Massive intercalary reconstruction of lower limb after wide excision of malignant tumors: an alternative to amputation or rotationplasty.
abstract: In this study, we present the feasibility of intercalary limb resection and massive reconstruction for malignant tumors of lower extremity. Ten cases of lower extremity malignancies that had undergone concomitant bone (and/or joint) and soft-tissue reconstruction after wide excision exceeding two-thirds of the cross-sectional area of the affected limb were reviewed. All cases were indicated for amputation because of an expansive tumor, hematoma from a pathologic fracture, or previous unplanned excision, with or without critical structure involvement. Bone was reconstructed with either an allograft or a tumor prosthesis. Soft-tissue reconstruction was performed to achieve critical structure and coverage, which was required in all cases. The resection margin was clear in all cases, and no soft-tissue graft failure was encountered. During a mean follow-up of 26 months (range, 9-42 months), no patient developed local recurrence in the resection-reconstruction site. Of the 10 patients, 8 patients were able to walk independently, and two were ambulatory but needed crutch support outdoors. Massive intercalary resection and reconstruction can be an effective treatment option for locally progressed or complicated lower extremity malignancies. Considering patient preference and the fair functional outcomes observed, it may be a useful alternative to amputation or rotationplasty.
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Han
authors.initials: SH
authors.lastname: Shin
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Keun-Ho
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Seung Pil
authors.initials: SP
authors.lastname: Jang
authors.affiliation: Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Goo-Hyun
authors.initials: GH
authors.lastname: Mun
authors.affiliation: Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Sung Wook
authors.initials: SW
authors.lastname: Seo
mesh_terms: D050398:Adamantinoma / Q000601:surgery; D000328:Adult; D000671:Amputation, Surgical; D001859:Bone Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D002648:Child; D005240:Feasibility Studies; D005260:Female; D005350:Fibroma / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control / Q000601:surgery; D012516:Osteosarcoma / Q000601:surgery; D017060:Patient Satisfaction; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome; D016138:Walking; D055815:Young Adult