Surgical Management of Bone Sarcomas with an Inappropriate Biopsy Site: A Case Series and Review of Literature
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Published on: September 9, 2020
Subbiah Shanmugam1, Syed Afroze Hussain1, Kishore Kumar Reddy1
1Centre for Oncology, Government Royapettah Hospital and Kilpauk Medical College, Chennai, India.
Aim:
To study bone sarcoma patients who underwent limb salvage surgery with an inappropriate biopsy site and their surgical management.
Materials And Methods:
There were 28 patients with bone sarcoma who underwent limb salvage surgery from 2015 - 2019, among them 4 patients had inappropriate biopsy scar. They were analyzed with respect to modification of incision, extent of flap elevation, difficulties in exposure of neurovascular structures, reconstructive methods and post-operative wound morbidity.
Results:
In all cases biopsy was done in outside hospital. One patient had open biopsy, remaining all were core needle biopsies. Out of the 4, three patients had distal femur lesion and one patient had proximal tibial lesion. Patient with proximal tibial lesion had biopsy site placed anteriorly over tibia. Patient underwent proximal tibial resection with anteromedial incision. Remaining three patients had distal femur lesion. One patient had pathological fracture with internal fixation done with lateral incision, and biopsy site placed medially. During surgery lateral incision was taken to include internal fixation scar with the distal end curved medially and extended over leg after including the biopsy site. One patient had distal femur lesion with laterally placed biopsy site, surgery done with lateral approach and medial gastrocnemius flap used to cover the prosthesis. One patient had anteriorly placed biopsy site, so after including the inappropriate biopsy site the lateral incision was curved medially and extended over leg. Two out of these four patients had skin necrosis; one patient had partial thickness skin necrosis and the other full thickness skin necrosis which was managed conservatively.
Conclusion:
In case of limb salvage surgery, skin incisions should be planned taking extent of lesion and biopsy scars into account. Good knowledge of vascular supply and incisions required if and when surgery is planned helps in selecting proper site for biopsy.
Insights
Limb salvage surgery requires careful planning of incisions to accommodate inappropriate biopsy sites, minimizing complications like skin necrosis. Proper biopsy site selection is crucial for successful bone sarcoma treatment.
Area of Science:
- Orthopedic oncology
- Surgical oncology
- Bone sarcoma research
Background:
- Limb salvage surgery is a critical treatment for bone sarcoma.
- Inappropriate biopsy sites can complicate surgical management.
- This study focuses on patients with bone sarcoma undergoing limb salvage surgery with prior suboptimal biopsy placement.
Observation:
- Four out of 28 bone sarcoma patients (2015-2019) had biopsy scars requiring surgical modification.
- Biopsies were predominantly core needle biopsies performed externally.
- Lesions included distal femur and proximal tibia, with varied biopsy site locations (anterior, medial, lateral).
Findings:
- Surgical approaches were modified to incorporate biopsy scars, involving altered incision lines and flap elevations.
- Complications included two cases of skin necrosis (partial and full thickness).
- Reconstructive methods and neurovascular structure exposure presented challenges.
Implications:
- Surgical planning for limb salvage must integrate biopsy site location and extent of the lesion.
- Understanding vascular supply and incision planning is vital for optimal biopsy site selection.
- Improved pre-operative planning can reduce post-operative morbidity in bone sarcoma surgery.
