| Abstract: |
Osteosarcoma is the most common malignant neoplasm of bone. Its distinguishing characteristic is the production of tumor osteoid or immature bone directly from a malignant spindle cell stroma. It occurs most often in the bones of the lower extremities and in the humerus of young patients.Due to the rapid and aggressive nature of the disease, the standard treatment for osteosarcoma was amputation of the affected limb. However, over the past three decades, the prognosis for patients with osteosarcoma has changed dramatically. The development of effective chemotherapy agents has reduced the incidence of metastatic disease and mortality. In addition, the advances in imaging and new materials and prostheses have provided the surgeon a more accurate preoperative plan and a broader range of operative alternatives. These advances have encouraged the development of better surgical techniques with less radical and definitive interventions.The development of surgical techniques and the application of radiotherapy and/or effective systemic chemotherapy has made limb salvage procedures a safe alternative to amputation and led to an increase in disease-free and overall survival rates.Limb salvage procedure includes tumor resection followed by reconstruction of the skeletal gap. Reconstruction comprises skeletal and soft tissue reconstruction. Many limb salvage options have been developed for treating patients with malignant bone tumors of the extremities, including resection of the tumor followed by arthrodesis of the joint, reconstruction with a bone graft (using vascularized/nonvascularized autograft reconstruction, an allograft alone, an osteochondral allograft, an allograft and endoprosthetic composite, or a synthetic bone graft), endoprosthetic reconstruction (utilizing total joint replacement or bone reconstruction), resection of the tumor followed by subsequent Ilizarov leg lengthening, and rotationplasty in some instances.The choice of a proper procedure needs to be made on an individual basis, by considering the radiological staging (the extent and anatomical location of the tumor, the existence of skip metastasis or lung metastasis, determination of the involvement of surrounding structures), pathological staging, and the clinical status (patient age, local soft-tissue condition, growth potential, work requirements, lifestyle).
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