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Segmental Resection and Replantation Have a Role for Selected Advanced Sarcomas in the Upper Limb

  • Soo Bong Hahn
  • Yun Rak ChoiEmail author
  • Ho Jung Kang
  • Kyoo Ho Shin
Original Article

Abstract

Although limb salvage surgery for primary sarcoma of the upper limb is a standard procedure, it often is technically challenging. We asked whether segmental resection and replantation would provide (1) local control and long-term survival and (2) useful limb function in patients who had advanced primary malignant and aggressive tumors of the upper limbs. We retrospectively reviewed six patients treated with this procedure when a wide resection around the tumor could not be achieved with other limb-salvage procedures. Diagnoses included osteosarcoma (two), Ewing’s sarcoma (one), leiomyosarcoma (one), and giant cell tumor (two). Four patients had displaced pathologic fractures. Minimum followup was 40 months (mean, 164 months; range, 40–214 months). All but one patient remained disease-free; the patient with Ewing’s sarcoma died from the disease 40 months after surgery. The average functional score at last followup was 20 points. The mean grasping and pinching power of the operative hand were 66% and 72% of the contralateral side, respectively. Two patients had complications: one had wound dehiscence that subsequently healed and one had radial nerve palsy that recovered spontaneously by 3 months. Segmental resection and replantation may have a role in selected cases for treatment of advanced primary sarcoma or aggressive giant cell tumor of the upper limb as partial limb salvage.

Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Keywords

Ulnar Nerve Giant Cell Tumor Coracoid Process Radial Nerve Palsy Primary Sarcoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

We thank Dong Su Jang and Dane K. Grace for their efforts in preparing the manuscript for publication.

References

  1. 1.
    Athanasian EA, Healey JH. Resection replantation of the arm for sarcoma: an alternative to amputation. Clin Orthop Relat Res. 2002;395:204–208.PubMedCrossRefGoogle Scholar
  2. 2.
    Athwal GS, Chin PY, Adams RA, Morrey BF. Coonrad-Morrey total elbow arthroplasty for tumours of the distal humerus and elbow. J Bone Joint Surg Br. 2005;87:1369–1374.PubMedCrossRefGoogle Scholar
  3. 3.
    Black AW, Szabo RM, Titelman RM. Treatment of malignant tumors of the proximal humerus with allograft-prosthesis composite reconstruction. J Shoulder Elbow Surg. 2007;16:525–533.PubMedCrossRefGoogle Scholar
  4. 4.
    Campanacci M, Giunti A, Olmi R. [Metaphyseal and diaphyseal localization of giant cell tumors] [in Italian]. Chir Organi Mov. 1975;62:29–34.PubMedGoogle Scholar
  5. 5.
    El-Gammal TA, El-Sayed A, Kotb MM. Resection replantation of the upper limb for aggressive malignant tumors. Arch Orthop Trauma Surg. 2002;122:173–176.PubMedCrossRefGoogle Scholar
  6. 6.
    Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241–246.PubMedGoogle Scholar
  7. 7.
    Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;153:106–120.PubMedGoogle Scholar
  8. 8.
    Gebhardt MC, Roth YF, Mankin HJ. Osteoarticular allografts for reconstruction in the proximal part of the humerus after excision of a musculoskeletal tumor. J Bone Joint Surg Am. 1990;72:334–345.PubMedGoogle Scholar
  9. 9.
    Getty PJ, Peabody TD. Complications and functional outcomes of reconstruction with an osteoarticular allograft after intra-articular resection of the proximal aspect of the humerus. J Bone Joint Surg Am. 1999;81:1138–1146.PubMedGoogle Scholar
  10. 10.
    Ghert MA, Abudu A, Driver N, Davis AM, Griffin AM, Pearce D, White L, O’Sullivan B, Catton CN, Bell RS, Wunder JS. The indications for and the prognostic significance of amputation as the primary surgical procedure for localized soft tissue sarcoma of the extremity. Ann Surg Oncol. 2005;12:10–17.PubMedCrossRefGoogle Scholar
  11. 11.
    Hahn SB, Kim NH, Choi NH. Treatment of bone tumors around the shoulder joint by the Tikhoff-Linberg procedure. Yonsei Med J. 1990;31:110–122.PubMedGoogle Scholar
  12. 12.
    Hahn SB, Park HJ, Kim HS, Kim SH, Shin KH. Surgical treatment of malignant and aggressive bone tumors around the knee by segmental resection and rotationplasty. Yonsei Med J. 2003;44:485–492.PubMedGoogle Scholar
  13. 13.
    Hanna SA, David LA, Aston WJ, Gikas PD, Blunn GW, Cannon SR, Briggs TW. Endoprosthetic replacement of the distal humerus following resection of bone tumours. J Bone Joint Surg Br. 2007;89:1498–1503.PubMedCrossRefGoogle Scholar
  14. 14.
    Ilizarov S, Blyakher A, Rozbruch SR. Lengthening of a free fibular graft after sarcoma resection of the humerus. Clin Orthop Relat Res. 2007;457:242–246.PubMedGoogle Scholar
  15. 15.
    Kawaguchi N, Matumoto S, Manabe J. New method of evaluating the surgical margin and safety margin for musculoskeletal sarcoma, analysed on the basis of 457 surgical cases. J Cancer Res Clin Oncol. 1995;121:555–563.PubMedCrossRefGoogle Scholar
  16. 16.
    Kulkarni A, Fiorenza F, Grimer RJ, Carter SR, Tillman RM. The results of endoprosthetic replacement for tumours of the distal humerus. J Bone Joint Surg Br. 2003;85:240–243.PubMedCrossRefGoogle Scholar
  17. 17.
    Kumar D, Grimer RJ, Abudu A, Carter SR, Tillman RM. Endoprosthetic replacement of the proximal humerus: long-term results. J Bone Joint Surg Br. 2003;85:717–722.PubMedGoogle Scholar
  18. 18.
    Mann GN. Less is (usually) more: when is amputation appropriate for treatment of extremity soft tissue sarcoma? Ann Surg Oncol. 2005;12:1–2.PubMedCrossRefGoogle Scholar
  19. 19.
    Murray PM. Free vascularized bone transfer in limb salvage surgery of the upper extremity. Hand Clin. 2004;20:vi, 203–211.Google Scholar
  20. 20.
    Shin KH, Park HJ, Yoo JH, Hahn SB. Reconstructive surgery in primary malignant and aggressive benign bone tumor of the proximal humerus. Yonsei Med J. 2000;41:304–311.PubMedGoogle Scholar
  21. 21.
    Tamurian RM, Gutow AP. Amputations of the hand and upper extremity in the management of malignant tumors. Hand Clin. 2004;20:vi, 213–220.CrossRefGoogle Scholar
  22. 22.
    Windhager R, Millesi H, Kotz R. Resection-replantation for primary malignant tumours of the arm: an alternative to fore-quarter amputation. J Bone Joint Surg Br. 1995;77:176–184.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2009

Authors and Affiliations

  • Soo Bong Hahn
    • 1
  • Yun Rak Choi
    • 1
    Email author
  • Ho Jung Kang
    • 1
  • Kyoo Ho Shin
    • 1
  1. 1.Department of Orthopaedic SurgeryYonsei University College of MedicineSeoulSouth Korea

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