title: Intraoperative extracorporeal autogenous irradiated tendon grafts for functional limb salvage surgery of soft tissue sarcomas of the wrist and hand.
abstract: BACKGROUND
  In patients with soft tissue sarcoma of the wrist and hand, limb salvage operation is extremely challenging for surgeons in attempting a complete tumor resection with negative surgical margins. In this study, we report four patients with soft tissue sarcoma of the wrist and hand treated by limb salvage operation with intraoperative extracorporeal autogenous irradiated tendon grafts.
  
  
  METHODS
  The patients were all male, and the mean age at the time of surgery was 45 years. Histological diagnoses included clear cell sarcoma in two patients, synovial sarcoma in one, and angiosarcoma in one. All four patients had high grade tumors, wherein three had American Joint Committee on Cancer (AJCC) stage III disease and one with AJCC stage IV disease. The tumors were resected en bloc with involved tendons. The tendons were isolated from the resected tissues, irradiated ex vivo, and re-implanted into the host tendons. In one patient, the bone was resected additionally because of tumor invasion to the bone. Hand function was evaluated using Musculoskeletal Tumor Society (MSTS) rating system.
  
  
  RESULTS
  Of the four patients, three died of distant metastatic disease. The remaining patient lives and remains disease-free. The mean follow-up period was 33 months. One patient had local recurrence outside the irradiated graft at 20 months after surgery. The functional rating was 22. Lower scores were seen in patients with reconstruction of flexor tendons than extensor tendons.
  
  
  CONCLUSIONS
  Limb salvage operation with intraoperative extracorporeal autogenous irradiated tendon grafts is an acceptable method in selected patients with soft tissue sarcoma of the wrist and hand.
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan. somrious@hotmail.com.
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Omori
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan. kenham73@gmail.com.
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Hamada
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan. hidetatsu77@gmail.com.
authors.forename: Hidetatsu
authors.initials: H
authors.lastname: Outani
authors.affiliation: Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari, Osaka, 537-8511, Japan. oshima-ka@mc.pref.osaka.jp.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Oshima
authors.affiliation: Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari, Osaka, 537-8511, Japan. jouyama-su@mc.pref.osaka.jp.
authors.forename: Susumu
authors.initials: S
authors.lastname: Joyama
authors.affiliation: Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari, Osaka, 537-8511, Japan. yasuhiko-tomita@umin.ac.jp.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Tomita
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan. nnaka@ort.med.osaka-u.ac.jp.
authors.forename: Norifumi
authors.initials: N
authors.lastname: Naka
authors.affiliation: Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari, Osaka, 537-8511, Japan. araki-no@mc.pref.osaka.jp.
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Araki
authors.affiliation: Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan. yhideki@ort.med.osaka-u.ac.jp.
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D000328:Adult; D064592:Autografts; D006225:Hand / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012509:Sarcoma / Q000601:surgery*; D013710:Tendons / Q000000981:diagnostic imaging / Q000637:transplantation*; D014953:Wrist / Q000601:surgery*