Introduction: SCC is a rare but well-known complication of chronic osteomyelitis since 1835, with an incidence from 0.5 to 2.3%. Amputation has generally been the treatment of choice; in selected Patients, Limb-salvage procedures have been employed 28 cases are presented here.
Materials and Methods: From 1975 to 2000, 4089 Patients with ostemyelitis were admitted to our service. SCC was present or arising in 28 cases: they were all middle aged males, except one woman. Mean age was 56.6 yrs, range 40–72. Clinical data were pointed out, and in all of them single or multiple biopsy was performed.
Results: All the cases were affected by SCC in the lower limb: tibia was the main site 20, followed by hip (2), foot (2), femur (4). Bone infection was born over 40 yrs. before (range 21–57). Patients were painfree up to 51 years. From worsening symptoms to admission, time was about 9 months (1–24). 19/28 cases came with wide leg ulcers, the rest with one discharging sinus or more (up to 8). In 6 cases pathological fracture was observed. Microbiological yields were not significant.
13 cases were transferred to Bone Tumors Centers: 10 of them were lost at F.U. Among those who underwent amputation: in two of them, local recurrence was observed, and one deceased after two years. Another Patient deceased for non-related heart problems.
Conclusions: In chronic osteomyelitis relapses are frequent, malignancy rare. If clinical changes in lower limb are observed, (pain, increased discharge, fethor, enlarging ulcer), SCC must be suspected. Early diagnosis is vital: biopsy should be wide, deep, multifocal, including the marrow space. Amputation is the treatment of choice. Metastases occur in 18 months; prognosis after 3 yrs from surgery is good.
Aetiology is still unknown: there is no evidence for an initiating factor. About favouring conditions ( inflammation, lower limb,) data are not clear enough.
In limb preserving surgery, our experience suggests one-stage procedures, avoiding to re-create chronic inflammation near the site of cancer.
