[Conservative surgical treatment of osteogenic sarcoma of the limbs. Technics and functional results]

Sixty-three osteogenic sarcomata of the limbs in patients aged between 10 and 20 years were treated by en bloc resection combined with chemotherapy. A review was made after an average follow-up of less than four years, which is too short a time to assess the carcinologic value of this type of treatment but sufficiently long to assess functional results and surgical technique. The resection was made through apparently normal tissues, thanks to meticulous pre-operative investigation and an appreciation of the extent of the tumour at operation. The tissues contaminated by a biopsy were removed. Three local recurrences were seen and in three other cases further extension in the operated limb was due to metastases. Reconstruction almost always utilised inert prosthetic implants often made during the pre-operative phase of chemotherapy. In cases of resection of the upper tibia an original procedure was developed to reconstruct the quadriceps using muscle-plasties. In 32 out of 39 knees, the immediate functional result was good. Only 10 still survived after two years, with nine good functional results. The authors conclude that en bloc resection is preferable to amputation in young patients both for those who will have a limited survival and those who will have long survival because of improvements in chemotherapy treatment. The risk of secondary loosening requires the use of more grafting procedures in reconstruction.