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Frontiers in Surgery 2021We report on a case of a large atypical cartilaginous tumor of the pelvis and its novel surgical resection with an anterior hemipelvectomy and reconstruction with an...
We report on a case of a large atypical cartilaginous tumor of the pelvis and its novel surgical resection with an anterior hemipelvectomy and reconstruction with an iliac crest graft. Surgical intervention is the mainstay treatment of pelvic chondrosarcomas. However, there have been reports of concern regarding preventing pelvic visceral herniation and adequately reconstructing the pelvis. This report is unique within the literature and has yielded good functional outcomes whilst achieving satisfactory surgical margins and minimizing morbidity.
PubMed: 34095198
DOI: 10.3389/fsurg.2021.585600 -
Orthopaedics & Traumatology, Surgery &... Feb 2010Bone hydatid disease is a rare pathology, characterized by its long clinical latency, the absence of radiological specificity as well as its challenging surgical...
Bone hydatid disease is a rare pathology, characterized by its long clinical latency, the absence of radiological specificity as well as its challenging surgical treatment. We report an observation of pelvic bone hydatidosis in a 28-year-old patient, appearing with pain and stiffness of the hip as well as a degenerative aspect on the coxofemoral joint on X-ray. The treatment consisted of an extensive hemipelvectomy with femoro pelvic arthrodesis, completed by medical treatment. The functional result was excellent in spite of a break in the fixation material, which allowed a certain mobility at the proximal end of the femur. Hydatid disease of bone is infiltrating,diffuse, slow, and progressive, all characteristics explaining the often-delayed diagnosis. Medical imaging provides accurate analysis for planning a broad surgical resection. The quality of surgical resection is determined according to the risk of recurrence. Pelvic locations are particularly difficult to treat. After an enlarged and difficult surgical resection, reconstruction remains aleatory and poses many technical problems.
Topics: Adult; Albendazole; Anthelmintics; Arthrodesis; Bone Diseases; Bone Screws; Combined Modality Therapy; Diagnosis, Differential; Echinococcosis; Humans; Magnetic Resonance Imaging; Male; Reoperation; Tomography, X-Ray Computed
PubMed: 20170864
DOI: 10.1016/j.rcot.2009.12.005 -
Joint Diseases and Related Surgery 2022This study aims to evaluate survival of patients and implants, functions, and morbidity of surgical technique of reconstruction with a fresh-frozen massive pelvic...
OBJECTIVES
This study aims to evaluate survival of patients and implants, functions, and morbidity of surgical technique of reconstruction with a fresh-frozen massive pelvic allograft following a pelvic resection.
PATIENTS AND METHODS
Between January 2009 and December 2016, a total of 19 patients (12 males, 7 females; mean age: 35.8±14.4 years; range, 10 to 53 years) who underwent reconstruction with fresh-frozen massive allograft after internal hemipelvectomy were retrospectively analyzed. Patients̓ age, sex, resection types, histopathology and grades, surgical margins, operative times, intraoperative blood loss, complications experienced during their treatment (infection, dislocation, implant failure, nonunion, local recurrence and metastasis), neoadjuvant and adjuvant therapies they received, and functional scores were revealed and analyzed in 10 years period.
RESULTS
According to the Enneking and Dunham classification, two (10%) patients had type I resection only, six (32%) had type I-II, one (5%) had a type II resection, one (5%) had type II-III resection, three (16%) had type I-II-III resection, one (5%) had type I-IV resection, and five (26%) had type I-II-IV resection. The resection involved the acetabulum (type II) in all, but three patients. Several complications were seen in 12 patients, although seven patients had no complication. Pelvic resections had a high mortality rate in patients with malignant tumors and reconstruction with massive allograft had a high morbidity rate with susceptibility to many complications. Prolonged surgical time was found to be directly related to blood loss. Deep infection significantly worsened functional results.
CONCLUSION
Despite the high complication rates seen in pelvic resections, massive pelvic allografts represent a valid option for reconstruction after resection of pelvic tumors, but due to the associated morbidity, patients should be carefully selected.
Topics: Adult; Allografts; Bone Neoplasms; Female; Humans; Male; Middle Aged; Pelvic Bones; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 35361086
DOI: 10.52312/jdrs.2022.344 -
Orthopedic Reviews Mar 2011After the first hemipelvectomy in 1891 significant advances have been made in the fields of preoperative diagnosis, surgical technique and adjuvant treatment in patients...
After the first hemipelvectomy in 1891 significant advances have been made in the fields of preoperative diagnosis, surgical technique and adjuvant treatment in patients with pelvic tumors. The challenging surgical removal of these rare malignant bone or soft tissue tumors accompanied by interdisciplinary therapy is mostly the only chance of cure, but bares the risk of intensive bleeding and infection. The reconstruction after hemipelvectomy is of importance for the later outcome and quality of life for the patient. Here, plastic surgery with microvascular free flaps or local rotational flaps improved the reconstruction and reduced infection rates. Average local recurrence rates of 14% demonstrate good surgical results, but 5 year survival rates of only 50% are described for some tumor entities, showing the importance of a multimodal collaboration. On a basis of a selective literature review the history, indications, treatment options and outcome of hemipelvectomies are presented.
PubMed: 21808716
DOI: 10.4081/or.2011.e4 -
The Journal of International Medical... Jun 2020Primitive neuroectodermal tumours (PNETs) are rare malignant small round cell tumours. Notably, despite widespread reports of PNET in multiple parts of the body, it is... (Review)
Review
Primitive neuroectodermal tumours (PNETs) are rare malignant small round cell tumours. Notably, despite widespread reports of PNET in multiple parts of the body, it is extremely rare in the pelvis. Here, a rare case of giant PNET of the pelvis, that was treated with surgical intervention comprising hemipelvectomy and amputation, is reported. A 42-year-old female patient presented with an enlarged mass on the left hip and severe pain in the left lower extremity for the previous 6 months. Preoperative imaging examinations indicated an irregular soft tissue-like signal shadow sized 19 × 15 × 12 cm at the left ilium and sacrum. After surgical intervention involving left hemipelvectomy and amputation, the tumour was diagnosed by pathology as PNET. During the courses of postoperative radiotherapy and chemotherapy, local recurrence and distant metastasis occurred, and the patient died 9 months following surgical treatment. To the best of the authors' knowledge, the current case is the largest pelvic PNET resection reported to date. Pelvic PNET is extremely malignant and has a high mortality rate regardless of surgical treatment, however, surgical resection of the lesion may relieve the symptoms, extend life, and improve quality of life to a certain extent.
Topics: Adult; Biopsy; Female; Humans; Neoplasm Recurrence, Local; Neuroectodermal Tumors, Primitive; Pelvic Neoplasms; Pelvis; Quality of Life
PubMed: 32500784
DOI: 10.1177/0300060520906747 -
Journal of Orthopaedic Surgery and... Apr 2016Metastatic lesions localized in the periacetabular area cause troublesome pain and reduced mobility of the patients. Radiotherapy effectively decreases pain, yet it does...
BACKGROUND
Metastatic lesions localized in the periacetabular area cause troublesome pain and reduced mobility of the patients. Radiotherapy effectively decreases pain, yet it does not restore the ability to load the joint. Surgical treatment involving resection of metastatic lesions and joint reconstruction using bone grafts is burdened with a high rate of complications. Modular tumor prostheses are being increasingly used. In some cases, it is possible to strengthen the acetabular roof with bone cement using vertebroplasty kits. The aim of the study was to demonstrate various methods of treatment of metastatic lesions localized in the periacetabular area together with the analysis of their results and effectiveness.
METHODS
Between 2010 and 2015, 27 patients with cancer metastases to the acetabulum were treated at our department. Qualification for surgical treatment was multifaceted with numerous aspects being considered. They included patients' general condition, type of neoplasm, clinical stage, and prognosis. CT and MRI scans of the pelvis were performed in each case. Before the surgery and 3 months following the surgery, visual analogue scale (VAS) pain intensity, Karnofsky functional status, and motor ability according to the Harris scale were evaluated. Bone cement (PMMA)-augmentation was performed in 21 patients, of whom nine had cement injected precutaneously and 12 at proximal femur resection alloplasty. Hemipelvectomy Type II combined with implantation of LUMiC resection prosthesis of the acetabulum were performed in six cases.
RESULTS
The quality of life improved in all the patients. After percutaneous cement injection, the mean pain intensity VAS score was 2.7, and the mean Karnofsky functional status score was 71.8. The mean postoperative Harris hip score (HHS) was 94 points. The patients who had undergone resection alloplasty on the proximal femur combined with periacetabular cement injection were walking using one crutch. In this group of patients, the mean postoperative pain intensity, functional status, and gait efficiency scores were 4.5, 65.7, and 82 points, respectively. The mean pain intensity VAS score in patients who had LUMiC prostheses implanted was 3.4. Their mean functional status score was 65 and the gait efficiency score 71 points. All the patients were able to walk on crutches.
CONCLUSIONS
Strengthening of the acetabular roof with bone cement in a specific group of patients is an adequate method of treatment which decreases pain and allows for loading the affected limb while walking. Internal hemipelvectomy combined with LUMiC prosthesis implantation makes it possible for the patients to walk using crutches and significantly reduces pain.
Topics: Acetabuloplasty; Acetabulum; Adult; Aged; Aged, 80 and over; Bone Cements; Bone Neoplasms; Cementation; Female; Follow-Up Studies; Gait; Hemipelvectomy; Hip Prosthesis; Humans; Karnofsky Performance Status; Male; Middle Aged; Pain Measurement; Quality of Life; Radiography; Recovery of Function; Tomography, X-Ray Computed
PubMed: 27125184
DOI: 10.1186/s13018-016-0384-z -
International Orthopaedics 2002We treated nine consecutive patients by internal hemipelvectomy and reconstruction with custom-made megaprosthesis between 1990 and 1997. Four had a primary malignant...
We treated nine consecutive patients by internal hemipelvectomy and reconstruction with custom-made megaprosthesis between 1990 and 1997. Four had a primary malignant bone or soft tissue tumour, one a recurrent benign giant cell tumour, three solitary metastatic bony lesions, and one a pelvic defect secondary to multiple revision procedures after total hip replacement. After a mean follow-up period of 62 (40-102) months five patients were still alive, including four of the eight patients with tumours. Three patients died as a result of the malignant disease, and one died of an infection related to the surgical treatment after 10-41 months. In two patients removal of the prosthesis was required due to infection, and six patients suffered various complications. One patient had an excellent outcome.
Topics: Adolescent; Adult; Aged; Bone Neoplasms; Female; Hemipelvectomy; Humans; Male; Middle Aged; Pelvic Bones; Postoperative Complications; Prostheses and Implants; Survival Analysis; Treatment Outcome
PubMed: 12078881
DOI: 10.1007/s00264-001-0322-4 -
Acta Ortopedica Mexicana 2011The treatment of bone pelvic tumors is associated with high compli cation rates. The surgeon usually has to decide between external and internal hemipelvectomy.
INTRODUCTION
The treatment of bone pelvic tumors is associated with high compli cation rates. The surgeon usually has to decide between external and internal hemipelvectomy.
OBJECTIVE
To describe the frequency of infectious and wound-related complications in a group of patients undergoing hemipelvectomy for different types of musculoskeletal tumors.
MATERIAL AND METHODS
This is an observational, descriptive, retrospective study with a single measurement. We observed the complications that occurred in eight patients treated with different modalities of hemipelvectomy without reconstruction. Infectious and wound-related complications were described as follows: a) no complications, b) seroma, c) hematoma, d) mild infectious process, e) moderate infectious process, f) severe infectious process, and g) flap necrosis. Internal hemipelvectomies were classified usin Enneking and Dunham's criteria.
RESULTS
Eight patients were assessed. Five patients underwent external hemipelvectomy and three internal hemipelvectomy. Two patients had no complications (25%), three had seromas (37.5%), one patient wa treated for a mild infectious process (12.5%) and two for severe infectious processes (25%). 75% of the patients had complications. No cases of flap necrosis were observed.
DISCUSSION
The surgeon decides which the best procedure in each case is. Different types of complications of hemipelvectomy have been reported; the most common ones are infectious processes and flap necrosis, and our results are similar to those reported by other authors.
CONCLUSIONS
Pelvic bone tumors are usually large masses that hinder the achievement of tumor-free surgical margins. There is a high likelihood of postoperative wound complications.
Topics: Adolescent; Adult; Aged; Bone Neoplasms; Child; Female; Humans; Longitudinal Studies; Male; Middle Aged; Orthopedic Procedures; Postoperative Complications; Retrospective Studies; Young Adult
PubMed: 22512122
DOI: No ID Found -
Journal of Fungi (Basel, Switzerland) Sep 2020Cutaneous invasive fungal wound infections after life-threatening dismounted complex blast injury (DCBI) and natural disasters complicate clinical care. These wounds...
Cutaneous invasive fungal wound infections after life-threatening dismounted complex blast injury (DCBI) and natural disasters complicate clinical care. These wounds often require aggressive repeated surgical debridement, can result in amputations and hemipelvectomies and have a 38% mortality rate. Given the substantial morbidity associated with cutaneous fungal wound infections, patients at risk need immediate empiric treatment mandating the use of rapidly acting broad-spectrum antimicrobials, acting on both fungi and bacteria, that are also effective against biofilm and can be administered topically. Designed antimicrobial peptides (dAMPs) are engineered analogues of innate antimicrobial peptides which provide the first line of defense against invading pathogens. The antifungal and antibacterial effect and mammalian cytotoxicity of seven innovative dAMPs, created by iterative structural analog revisions and physicochemical and functional testing were investigated. The dAMPs possess broad-spectrum antifungal activity, in addition to being effective against Gram-negative and Gram-positive bacteria, which is crucial as many wounds are polymicrobial and require immediate empiric treatment. Three of the most potent dAMPs-RP504, RP556 and RP557-possess limited mammalian cytotoxicity following 8 h incubation. If these encouraging broad-spectrum antimicrobial and rapid acting results are translated clinically, these novel dAMPs may become a first line empiric topical treatment for traumatic wound injuries.
PubMed: 32971819
DOI: 10.3390/jof6030184 -
Journal of Clinical Orthopaedics and... 2017The management of pelvic sarcoma is challenging and goals of surgery are adequate oncologic local control, maintenance of optimum function with good quality of life.
INTRODUCTION
The management of pelvic sarcoma is challenging and goals of surgery are adequate oncologic local control, maintenance of optimum function with good quality of life.
METHODS
We have evaluated the results of internal hemipelvecotmy including age, type of resection, reconstruction, radiotherapy or chemotherapy. From 2010 to 2016, 23 patients with pelvic bone tumors (13 with Ewing's sarcoma, 9 with Osteosarcoma, 1 with chondrosarcoma) were treated by surgical resection.
RESULTS
The mean follow-up was 18 months (0.5-5) years. In 12 patients reconstruction was performed and 11 were without reconstruction. A total of 3 patients (13%) had an infection develop at a mean follow up of 1 month. Surgical debridement's and antibiotics in three patients led to complete recovery. One patient had sciatic nerve injury.One patient had injury to femoral vein; was treated with femoral vein reconstruction. Two patients (9%) developed a local recurrence and were treated with best supportive treatment. Distal pulmonary metastases were seen in four patients and treated with supportive treatment. Five-year disease-specific survival rates of all patients were 83%. The mean functional MSTS score was 18(14-24).
CONCLUSIONS
Proper selection of patients, preopertive planning and wide surgical margins with reconstruction provides good functional outcomes following internal hemipelvectomy. The surgical site infection and flap necrosis tend to be minor complication and can be managed leading to optimal outcomes and justifies the need for this complex surgery. The oncological and functional outcome after internal hemipelvectomy suggests that it's an effective method for treatment of patients with pelvic sarcomas.
PubMed: 28951642
DOI: 10.1016/j.jcot.2017.04.004