We conducted a retrospective study of 61 patients, suffering from osteosarcoma, who presented to the CMJAH tumour Unit between 2007 and 2011. The average time to presentation to the unit, post-onset of symptoms, was 4.5 months. Most patients, 43/61 (70%), presented initially to a hospital or clinic; only 3/61patients (5%) presented first to traditional healers and 15/61 (25%) to a GP. 16 patients (26%) came from other South African provinces and 3 patients (5%) were international. 3 Patients (5%) presented with a pathological fracture. 3/61 (5%) patients were HIV positive, 8 unknown and the rest were HIV negative. A standard osteosarcoma work-up was performed. 4 patients (7%) were Enneking Stage 2A, 41 patients (67%) were Stage 2B and 16 patients (26%) presented with metastases (Stage 3). Biopsy was performed on average of 3 weeks post-presentation (delay largely due to MRI). Surgery was undertaken in 46 patients (75%), with the aim of achieving wide local resection margins: 13 (21%) limb salvage procedures and 33 (79%) limb ablations were performed. 4 patients refused further treatment. 54/57 patients (95%) underwent chemotherapy and, of these, 44 (81%) underwent a neo-adjuvant chemotherapy protocol and 2 patients (4%) received post-adjuvant chemotherapy only. 19/61 patients (31%) defaulted follow-up: of these 19 patients, 15 (79%) were amputees, 1 (5%) was a limb salvage patient and 4 (16%) were un-operated. Two patients developed local recurrence: 1 was treated with amputation & the other with further excision. Palliative Radiotherapy was administered to 2 patients. In March 2013, 41 patients were contactable. Of these, 17/41 (41%) were alive and of the surviving 17 patients, 9 (81%) were limb salvage patients and 6 (38%) were amputees. Of the 12 patients, who had initially presented with metastases, only I patient (8%) was alive. Only 1 of the 3 patients, who initially presented with pathological fracture, was traceable and alive. NO DISCLOSURESIntroduction
Results
The benefits of the Lautenbach suction-instillation have been recognised as an adjunct to the eradication of bone and joint infection. With the wide acceptance of external suction dressings as a means of accelerating wound healing and evacuating exudates, there are advantages to a system which combines these benefits for deep cavities with the direct infusion of antibiotics to increase local tissue concentrations. This is particularly useful in the extensive tissue defects encountered with wide excision of musculoskeletal tumours and reconstruction with mega prostheses or bulk allograft (with many patients undergoing adjuvant chemo- and radiotherapy), and also in complex orthopaedic trauma cases with tissue loss. These situations are associated with a reported infection incidence of up to 40%. The results of use of the Lautenbach suction-instillation system were studied prospectively in 100 patients over a 7 year period. Sixty cases followed wide excision of musculoskeletal tumours and 40 were caused by complex trauma. Due to logistics, many tumour cases were managed post-operatively in a septic orthopaedic ward. Immediate soft tissue cover was achieved in all tumour cases, utilising flaps where necessary, but cover was delayed for up to 3 weeks in some trauma cases. One late infection (2 years post-op) in a bulk allograft reconstructed sarcoma patient and 1 trauma infection were noted. Both were successfully eradicated with a secondary debridement & Lautenbach suction-instillation.Materials.
Results.
Previous incisions around the knee may complicate subsequent total knee arthroplasty (TKA) because they can lead to skin problems, with wound breakdown and a risk of sepsis. Our database contains details of 925 TKAs, 851 primary and 74 revision procedures. Of the 851 primary TKA patients, 368 had previously undergone knee surgery, 72 of them more than once. Twenty of the 74 patients who underwent revision TKA had undergone one previous procedure (excluding the primary TKA), and 24 had undergone multiple procedures. We clinically reviewed 133 TKAs, classifying previous procedures into midline (24), medial (50), lateral (26) and transverse (13) procedures. In 53 cases there had been previous arthroscopic procedures. Excluding the arthroscopies, previous scars were followed in 20 cases, partially followed in 11 cases and ignored in 53 cases. Following up patients for a minimum of six months, we saw only six cases with minor wound edge slough. These did not require further surgery. Three of the six patients were in the group of 442 with previous scars, and three in the group of 483 without previous scars. All patients had spinal anaesthesia, peri-operative oxygen, vacuum drainage and a delayed knee-bending program, which we believe contributed to the low incidence of wound problems. We believe that previous scars should be followed if they are approximately in the line of a normal midline TKA incision, and that scars beyond the midline can be ignored without increasing the risk of skin necrosis.
Previous incisions around the knee may complicate subsequent total knee replacement (TKR) surgery because they can lead to skin problems, with wound breakdown and a risk of sepsis. Our database contains details of 925 TKRs, 851 primary and 74 revision procedures. Of the 851 primary TKR patients, 368 had previously undergone knee surgery, 72 of them more than once. Twenty of the 74 patients who underwent revision TKR had undergone one previous procedure (excluding the primary TKR), and 24 had undergone multiple procedures. We clinically reviewed 133 TKRs, classifying previous procedures into midline (24), medial (50), lateral (26) and transverse (13) procedures. In 53 cases there had been previous arthroscopic procedures. Excluding the arthroscopies, previous scars were followed in 20 cases, partially followed in 11 cases and ignored in 53 cases. Following up patients for a minimum of six months, we saw only six cases with minor wound edge slough. These did not require further surgery. Three of the six patients were in the group of 442 with previous scars, and three in the group of 483 without previous scars. All patients had spinal anaesthesia, peri-operative oxygen, vacuum drainage and a delayed knee-bending program, which we believe contributed to the low incidence of wound problems. We believe that previous scars should be followed if they are approximately in the line of a normal midline TKR incision, and that scars beyond the midline can be ignored without increasing the risk of skin necrosis.
