The role of perioperative antibiotic prophylaxis in sarcoma surgery is well established. There are no guidelines for their use in this context but there is pressure from microbiologists to comply with agreed prophylaxis for joint arthroplasty despite major differences between patient groups and risks of infection in sarcoma surgery. Two simple surveys were conducted online, the first for bone sarcoma surgery, the second for soft tissue sarcomas. An email was sent to the major centres worldwide conducting such surgery with links to the online surveys to assess current practice regarding antibiotic prophylaxis and surgical drains. The survey was limited to 8 questions, the emphasis being a simple survey, but included questions on indications, choice, duration of therapy as well as use, size and duration of surgical drains. We received 38 responses from 15 countries to the bone sarcoma survey and 33 responses from 12 countries to the soft tissue sarcoma survey. Current antibiotic prophylaxis regimens varied widely among surgeons, emphasising the controversy that exists regarding what constitutes best clinical practice. Opinions regarding use of perioperative antibiotic prophylaxis in sarcoma surgery vary widely among orthopaedic surgeons worldwide, illustrating the controversy as to what constitutes best clinical practice. This survey suggests the need for a randomised clinical trial to aid in the development of guidelines in this area

Extracorporeal irradiation and re-implantation of a bone segment is a technique employed in bone sarcoma surgery for limb salvage in the setting of reasonable bone stock. There is neither consensus nor rationale given for the dosage of irradiation used in previous studies, with values of up to 300Gy applied. We investigated the influence of extracorporeal irradiation on the elastic and viscoelastic properties of bone. Bone specimens were extracted from mature cattle and subdivided into thirteen groups; twelve groups exposed to increasing levels of irradiation and a control group. The specimens, once irradiated, underwent mechanical testing in saline at 37°C. Mechanical properties were calculated by experimental means which included Young's Modulus, Storage Modulus and Loss Modulus. These were all obtained for comparison of the irradiated specimens to the control group. There were non-significant negligible changes in all of the mechanical properties of bone that were assessed with increasing dosage of irradiation. Therefore, we conclude that the overall mechanical effect of high levels of extracorporeal irradiation (300Gy) is minute, and can be administered to reduce the risk of malignancy recurrence

Curettage and packing with polymethylmethacrylate cement is a routine treatment for giant-cell tumour (GCT) of bone. We performed an in vitro evaluation of the cytotoxic effect of a combination of cement and methotrexate, doxorubicin and cisplatin on primary cell cultures of stromal GCT cells obtained from five patients. Cement cylinders containing four different concentrations of each drug were prepared, and the effect of the eluted drugs was examined at three different time intervals.

We found that the cytotoxic effect of eluted drugs depended on their concentration and the time interval, with even the lowest dose of each drug demonstrating an acceptable rate of cytotoxicity. Even in low doses, cytotoxic drugs mixed with polymethylmethacrylate cement could therefore be considered as effective local adjuvant treatment for GCTs.