• The Journal of the Korean bone and joint tumor society
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• v.4 no.1
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• pp.53-58
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• 1998

Limb-salvage surgery has become more popular than amputation for the treatment of malignant bone tumor because no differences in local recurrence and the 5-year survival rate have been found. However for young patients with sarcoma, skeletal immaturity may be a contraindication to limb-salvage surgery due to the expected leg length discrepancy. If limb-sparing procedure should be impossible for skeletally immature patients, amputation has to be given first consideration. To minimize the functional difficulty from short amputation stump of above knee amputation, we performed lengthening of the amputation stump using ipsilateral tibia. One patient was lengthened 17cm using ipsilateral tibia and the other, 12cm. Two patients and their families were satisfied both clinically and psychologically.

• The Journal of the Korean bone and joint tumor society
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• v.12 no.2
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• pp.141-147
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• 2006

In 1996, a nine-year-old girl was treated with recycling autograft after wide resection of the distal femoral osteosarcoma. The leg lengthening and revision with growing tumor prosthesis were performed due to limb leg discrepancy and epiphyseal problem. However, deep infection developed after operation, and a temporary spacer with cement and Ender nail was inserted. After infection was controlled completely, the final leg lengthening was performed with mono-external fixator for limb length discrepancy (10 cm). Lastly, Tumor prosthesis was reinserted to preserve the joint function.

• Archives of Plastic Surgery
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• v.50 no.5
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• pp.501-506
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• 2023

This article portrays the authors' experience with a complex lower limb bone and soft tissue defect, following chronic osteomyelitis and pathological fracture, which was managed by the multidisciplinary orthoplastic team. The decision for functional amputation versus limb salvage was deemed necessary, enhanced by the principles of "spare parts" in reconstructive microsurgery. This case describes the successful use of the osteocutaneous distal tibia turn-up fillet flap that allowed "lowering the level of the amputation" from a through knee to a below-knee amputation (BKA) to preserve the knee joint function. We comprehensibly review reports of turn-up flaps which effectively lower the level of amputation, also applying "spare-parts" surgery principles and explore how these concepts refine complex orthoplastic approaches when limb salvage is not possible to enhance function. The osteocutaneous distal tibia turn-up fillet flap is a robust technique for modified BKA reconstructions that provides sufficient bone length to achieve a tough, sensate stump and functional knee joint.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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• pp.105-112
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• 1995

Soft tissue sarcomas are malignant tumors that arise in the extraskeletal connective tissues of the body. And the clinical behavior of soft tissue sarcomas is characterized by a tendency to extensively invade surrounding soft tissues as well as early metastatic dissemination. Difficulties were encounted when soft tissue sarcomas invade the major vessels. There are a few reprots about the reconstruction of the major vessels after resection of soft tissue sarcomas. We have treated 3 cases of the soft tissue sarcomas involving the major artery. After marginal excision of the tumor mass, the involved major artery was reconstructed with Gortex artificial vessel graft and we could salvage the patient's extremity.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.96-106
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• 2004

Purpose: To determine the usefulness of limb salvage operation with recycled autogenous bone graft in musculoskeletal malignant tumors. Materials and Methods: Twenty nine cases, who underwent limb salvage operation with recycled autogenous bone graft for the treatment of musculoskeletal malignant tumor between February 1990 and January 2003, were included. There were 18 males and 11 females and the mean age was 33 years (range, 10 to 65 years). The mean follow-up period was 51.8 months (range, 18 to 117 months). The Enneking stage was IIA in 10 cases and IIB in 19 cases. The recycling method of autogenous bone was deep freezing in 6 cases, autoclaving in 11 cases, pasteurization in 7 cases and the composite of autoclaving and vascularized fibular graft in 5 cases. The union of junctional site was evaluated radiologically and the functional results was analyzed by the grading systems of the International Symposium On Limb Salvages (ISOLS). Results: The mean union time was 7.2 months (range, 3 to 15 months). The union took 5.8 months (range, 4 to 8 months) in deep freezing, 9.7 months (range, 6 to 15 months) in autoclaving, 5.9 months (range, 4 to 8 months) in pasteurization, and 5 months (range, 4 to 8 months) in the composite of autoclaving and vascularized fibular graft. The mean functional evaluation percentage was 76.8% (range, 40 to 90%). It was 65.8% (range, 40 to 85%) in deep freezing, 76.6% (range, 40 to 90%) in autoclaving, 81.6% (range, 70 to 90%) in pasteurization, and 83.4% (range, 75 to 90%) in the composite of autoclaving and vascularized fibular graft. There were 6 cases of complications including 1 case of local recurrence, lung metastasis, infection, fracture, respectively and 2 cases of nonunion. Conclusion: The limb salvage operation with recycled autogenous bone graft is a useful treatment method for the musculoskeletal malignant tumors. Particularly, autoclaving is the most reliable sterilization method. The vascularized fibular graft can compensate decreased osteoinductivity and mechanical strength of recycled bone. So, the composite of autoclaving and vascularized bone graft seems to be a favorable treatment method for high grade malignant musculoskeletal tumors.

• Journal of Korean Foot and Ankle Society
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• v.17 no.1
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• pp.52-59
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• 2013

Purpose: The purpose of this study is to evaluate treatment results of multidisciplinary approach of critical ischemic limb with diabetic foot. Materials and Methods: From March 2005 to March 2012, 674 diabetic foot patients were analyzed. Among them, 85 patients were neuroarthropathic type, 383 patients were infectious type, and 206 patients were ischemic type. The subjects were 206 patients who had critical ischemic limbs and major or minor amputations were done. Various single or combined treatment method before amputation was performed. We investigated their ABI, HbA1c, main occlusion lesion, limb salvage and hospitalization period by various treatment method. Results: Major amputation was 27 cases, minor amputation was 179 cases. Mean HbA1c was 8.2%, and mean ABI was 0.66. Main occlusion lesion was 6 cases at common iliac artery, 13 cases at external iliac artery, 9 cases at internal iliac artery, 11 cases at common femoral artery, 23 cases at deep femoral artery, 52 cases at superficial femoral artery, 35 cases at popliteal artery, 40 cases at posterior tibia artery, 35 cases at anterior tibial artery, 28 cases at peroneal artery, and 13 cases at dorsalis pedis artery. Major amputations were decreased, minor amputations were increased, and hospitalization period was reduced by treatment of multidisciplinary approach. Conclusion: Treatment of multidisciplinary approach, which include preoperation percutaneus transluminal angioplasty, vascular surgery, and amputation, of critical ischemic limb with diabetic foot had advantages of limb salvage and hospitalization period reduction.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.2
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• pp.226-232
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• 1995

Survival rate of osteosarcoma has been improved recently due to the neoadjuvant and adjuvant chemotherapy. Limb-salvaging operation(LSO) has replaced the amputation technique without' lowering the survival rate. And there occurred a lot of patients who are suffering from the high cost of artificial implants and forced to choose amputation due to economic problem. In LSO, usually relatively high cost artifical implant is needed. When a patient and not afford such an expensive implant he had to choose an inexpensive way, amputation. Authors tried bone lengthening by adopting Ilizarov technique after wide resection of tumor in two patients. Bone transportation was successful in one patient and less successful in the other. One case in CDF(continuosly disease free since the surgical procedure) state at follow-up 3 year 4 months after knee joint fusion. And the other was given lobectomy for lung metastasis at postop. 1 year and 9 months, and given osteosynthesis for infected nonunion at the docking site. Bone transportation was thought to be a good method for the bony coverage of dead space caused by wide resection. Bone transportation technique was economical as well as biological We present two osteosarcoma patient who treated with Ilizarov bone transportation.

• Archives of Plastic Surgery
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• v.49 no.5
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• pp.696-700
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• 2022

We performed distal bypass and free flap transfer in a single-stage operation to repair an extensive soft tissue defect in an ischemic foot of an 84-year-old woman. The nutrient artery of the free flap was anastomosed to the bypass graft in an end-to-side manner. Subsequently, the bypass graft became occluded on several occasions. Although intravascular and surgical interventions were performed each time, the bypass graft eventually became completely occluded. However, despite late occlusion of the nutrient artery, the free flap has remained viable and the patient is ambulatory. The time required for a transplanted free flap to become completely viable without a nutrient artery is likely longer for an ischemic foot compared with a healthy foot. However, the exact period of time required is not known. A period of month was required in our patient. We report this case to help clarify the process by which a free flap becomes viable when applied to an ischemic foot.

• Journal of Trauma and Injury
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• v.32 no.2
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• pp.93-100
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• 2019

Purpose: Penetrating vascular trauma though less common poses a challenge to all Surgeons. This study was designed to analyse the profile, management modalities of vascular trauma and the outcomes thereof at a Trauma Care Centre in a Tertiary care setting in hostile environment in India. Methods: A prospective review of all patients with arterial and venous injuries being transferred to the Trauma Center at out Tertiary Care Center between June 2015 and May 2018 was done. Demographics, admission data, treatment, and complications were reviewed. Results: There were a total of 46 patients with 65 vascular injuries, 39 arterial injuries and 26 venous injuries. The age range was 21 to 47 years. Nineteen patients had both arterial and venous injuries. A total of 42 cases presented within 12 hours of injury and complete arterial transections were found in 33 cases (80.49%). There were three mortalities (6.52%) and three amputations (8.33%). The overall limb salvage rate was 91.67% with popliteal artery being the commonest injured artery. Poor prognosticators for limb salvage were increasing time to present to the trauma centre, hypovolemic shock, multi-organ trauma and associated venous injuries. Conclusions: Penetrating missile trauma leading to vascular injuries has not been widely reported. Attempting limb salvage even in cases with delayed presentation should be weighed with the threat to life before revascularisation and should preferably be done at a centre with vascular expertise. A team approach with vascular, orthopaedic, general surgeons, and critical care anaesthesiologists all aboard improve the outcomes manifold. Use of tourniquets and early fasciotomies have been emphasized as is the use of native veins as the bypass conduit. This is probably the largest study on penetrating Vascular trauma in anti-terrorism ops from the Indian subcontinent. It highlights the significance of prompt recognition and availability of vascular expertise in optimally managing cases of vascular trauma.

• The Journal of the Korean bone and joint tumor society
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• v.20 no.1
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• pp.7-13
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• 2014

Purpose: As well as patient survival, the restoration of postoperative function such as ambulation is important in limb salvage operations for treatment of malignant bone tumors involving the proximal femur. The authors analyzed clinical outcomes of limb salvage operations using tumor prostheses for metastatic or primary malignant bone tumors in the proximal femur. Materials and Methods: From February 2005 to January 2014, 20 cases (19 patients) with malignant bone tumor involving the proximal femur with pain or complicated pathologic fracture were treated with segmental resection and limb salvage operations with tumor prostheses. Mean age was 63.1 years (range 35-86). Fourteen patients were male and six ones were female. The mean follow-up period was 20 months (1-94 months). There were 15 cases of metastatic bone tumor, 4 cases of osteosarcoma, and 1 case of multiple myeloma. The primary tumors of the metastatic bone tumors included 4 lung cancers, 3 hepatocellular carcinomas, and 3 renal cell carcinomas. Other primary tumors were breast cancer, thyroid cancer, colon cancer, prostate cancer, and malignant spindle cell tumor, each in 1 case. Modular tumor prostheses were used in all cases; (Kotz's$^{(R)}$ Modular Tumor prosthesis (Howmedica, Rutherford, New Jersey) in 3 cases, MUTARS$^{(R)}$ proximal femur system (Implantcast, Munster, Germany) in 17 cases). Perioperative pain was assessed with Visual Analogue Scales (VAS). Postoperative functional outcome was assessed with Musculoskeletal Tumor Society (MSTS) grading system. Results: Out of 20 cases (19 patients), 11 cases (10 patients) survived at the last follow-up. Average postoperative survival of the 9 deceased patients was 10.1 months (1-38 months). VAS score improved from pre-operative average of 8.40 (5-10) to 1.35 (0-3) after operation. Average postoperative MSTS function score was 19.65 (65.50%, 7-28). The associated complications were 2 local recurrences, 3 hematomas, 3 infections, 2 scrotal swellings, and 1 dislocation. There was no case of periprosthetic fracture or loosening. Conclusion: Limb salvage operation with tumor prosthesis is an appropriate treatment for early pain reduction and functional restoration in malignant bone tumors in the proximal femur with pain an/or complicated pathologic fractures.