LIMB SALVAGE SURGERY FOR LOCALLY AGGRESSIVE AND MALIGNANT BONE-TUMORS

Since 1983, 77 patients have had limb salvage surgery for locally aggr essive or malignant bone tumor of the limbs or pelvis. Twenty-nine pat ients had locally aggressive lesions with giant cell tumors the most p revalent, and 48 patients had malignant lesions, of which osteosarcoma s predominated. Resection with a wide margin could be achieved in most of the patients. A mobile joint reconstruction was performed in 57 pa tients and an arthrodesis in 14 patients. At follow-up, 14 patients ha ve died of disease, 7 patients have survived with disease, and 56 pati ents (73%) have survived without disease. Local recurrences were encou ntered in 4 patients (5%). The overall functional results were classif ied as excellent in 11 patients, good in 45 patients, and fair in 9 pa tients. Twelve patients had poor results because of failure of the rec onstruction or amputation due to complications. Twenty-seven complicat ions were encountered, among which infection was the most serious. Car eful selection of patients and consideration of procedure chosen to re construct the defect are important for a successful outcome. This deci sion is based on a number of factors related to the tumor and the pati ent. Presently, major neurovascular involvement, displaced pathologica l fracture, inappropriate biopsy incision, extreme youth of the patien t, and infection were considered to be contraindications to resection in our institution. Although various procedures promise functional res toration, the reconstructive procedure should be individualized and de signed to meet the needs of the patient. (C) 1993 Wiley-Liss, Inc.