Marginal Skin Flap Advancement: A Technique to Optimize the Skin Graft Interface Following Tumor Resections.

Split-thickness skin graft (STSG) for soft tissue defects is often required following tumor resections. There is often a step-off with subcutaneous adipose tissue along the defect margins. This review of 20 years of experience was performed to determine the success of marginal skin flap advancement, a simple surgical technique addressing this issue.

Compromise of Radiology Studies From Nonstandardized Viewing Platforms.

There is no standardization of proprietary radiology viewing software platform functions allowing recorded digital radiographic imaging studies on compact discs (CDs) to be viewed in a standardized manner at subsequent institutions. Primary concerns include the following: (1) a large number of image viewing software platforms with a wide variety of features making familiarity with use difficult, (2) an inordinate amount of time required to load imaging data, (3) imaging data may not upload or be viewed with the care center's picture archiving and communication system, (4) navigation through imaging studies is inconsistent and tedious, and (5) image viewing requires additional software downloads. Additionally, images generated from "outside CDs" are frequently of low quality and resolution, eliminating the ability to render a reliable diagnosis.

Epidemiology and survivorship of soft tissue sarcomas in adults: a national cancer database report.

The National Cancer Data Base (NCDB) of the American College of Surgeons gather demographic and survival data on ~70% of cancers in the USA. We wanted to investigate the demographic and survivorship data on this potentially more representative cohort of patients with soft tissue sarcomas. We selected 34 of the most commonly encountered soft tissue sarcomas reported to the NCDB, provided that each entity contained a minimum of 50 cases.

Stemmed knee replacement in a patient with an irremovable tibial nail.

A patient with a cemented centrally located intramedullary tibial nail that occluded the proximal tibial canal underwent knee reconstruction with a total knee design utilizing a custom hollow tibial stem. In this oncology case, a rotating-hinge knee design was used that incorporates an intra-articular inverted post-in-channel central rotational post design. This design allowed for a rather straightforward reconstruction that functioned well for 3 years.

Glove and gown effects on intraoperative bacterial contamination.

Objective: Experiments were performed to determine the risk of bacterial contamination associated with changing outer gloves and using disposable spunlace paper versus reusable cloth gowns.

Background: Despite decades of research, there remains a lack of consensus regarding certain aspects of optimal aseptic technique including outer glove exchange while double-gloving and surgical gown type selection.

Methods: In an initial glove study, 102 surgical team members were randomized to exchange or retain outer gloves 1 hour into clean orthopedic procedures; cultures were obtained 15 minutes later from the palm of the surgeon's dominant gloved hand and from the surgical gown sleeve.

Osteosarcoma diagnostic delay associated with alendronate-induced pain relief.

A 32-year-old man with a painful osteoblastic osteosarcoma of the right hip was initially diagnosed as having Paget's disease of bone. He was treated with alendronate for presumptive Paget's disease. The patient's bone pain was dramatically reduced by the administration of alendronate for 7 months.

Femoral stress fractures associated with long-term bisphosphonate treatment.

Background: Recent studies have described unique clinical and radiographic characteristics of femoral stress fractures or low-energy fractures associated with long-term bisphosphonate therapy. However, it is unclear whether these fractures require subsequent surgery after the initial treatment.

Questions/purposes: We performed a cohort analysis of bisphosphonate-associated femoral stress fractures to (1) confirm the unique clinical and radiographic findings compared with existing literature, (2) determine whether any patients with completed fractures had no preexisting transverse stress fracture lines, (3) assess the need for additional surgical procedures, and (4) determine whether the hospital length of stay (LOS) differed for patients with prophylactic fixation of stress fractures versus fixation of completed fractures.

Hip resurfacing with retention of existing hardware - case report.

Despite operative reduction and internal fixation (ORIF), many patients who sustain proximal femur fractures develop posttraumatic arthritis. Conventional total hip arthroplasty (THA)in the setting of altered femoral morphology and retained hardware can be quite challenging. Hip resurfacing can provide a favorable option.

Primary total hip replacement versus hip resurfacing - hospital considerations.

Multiple factors regarding surgical procedures and patient selection affect hospital staffing needs as well as hospital revenues. In order to better understand the potential impact on hospitals that hip arthroplasty device selection (standard total hip arthroplasty vs. resurfacing) creates, a review of all primary hip arthroplasties performed at one institution was designed to identify factors that impacted hospital staffing needs and revenue generation.

Does a plastic drape reduce incidence of heterotopic ossification after hip resurfacing?

Background: High rates of heterotopic ossification have been associated with hip resurfacing as compared to THA. Bone debris from femoral head reamings is cited as one of the risk factors linked to increased rates of heterotopic ossification.

Questions/purposes: We therefore asked whether (1) the incidence of heterotopic ossification differed with and without the use of a plastic drape used to collect bone debris and (2) any of a number of variables (age, gender, diagnosis, previous hip surgery, operative time, and blood loss) related to the occurrence of HO.

Does computer-assisted surgery improve accuracy and decrease the learning curve in hip resurfacing? A radiographic analysis.

Background: Hip resurfacing is a technically demanding procedure in which accurate positioning of the femoral component is critical to the avoidance of early implant failures. The purpose of this study was to assess the accuracy of computer-assisted placement of the femoral component and to evaluate the impact of computer-assisted surgery on the learning curve associated with this procedure.

Methods: The accuracy of positioning the femoral component was analyzed radiographically in hips undergoing resurfacing procedures performed by surgeons assigned to four different study groups: Group 1, in which the operations were performed with use of computer-assisted surgery by a fellowship-trained surgeon who was experienced in performing resurfacing arthroplasty (surgical experience, more than 250 hip resurfacings); Group 2, in which the operations were performed with use of computer-assisted surgery by senior residents who were inexperienced in performing resurfacing arthroplasty and who were closely supervised by faculty; Group 3, in which the operations were performed with use of conventional instruments by fellowship-trained faculty members; and Group 4, in which the operations were performed with use of computer-assisted surgery by a lesser experienced fellowship-trained faculty member (surgical experience, more than forty but less than seventy-five hip resurfacings) from Group 3.

HLA sensitization and allograft bone graft incorporation.

Unlabelled: Achieving union between host bone and massive structural allografts can be difficult. Donor and recipient human leukocyte antigen (HLA) mismatches and recipient antibody response to donor HLA antigens might affect union. In a prospective multiinstitutional study, we enrolled a consecutive series of patients receiving cortex-replacing, massive structural bone allografts to determine the rate of donor-specific HLA antibody sensitization and to investigate the potential effect of such HLA alloantibody sensitization on allograft incorporation.

Tumors masquerading as hematomas.

Suboptimal patient management can occur when malignant soft tissue tumors with internal hemorrhage masquerade as simple hematomas. We retrospectively reviewed 31 patients with malignancies who had diagnostic delays averaging 6.7 months (range, 1.

Osteosarcoma, chondrosarcoma, and Ewing's sarcoma: National Cancer Data Base Report.

We summarize descriptive epidemiologic and survival data from the National Cancer Data Base of the American College of Surgeons for 26,437 cases of osteosarcoma (n = 11,961), chondrosarcoma (n = 9606), and Ewing's sarcoma (n = 4870) from 1985 to 2003. Survival data are reported on cases with a minimum 5-year followup from 1985 to 1998 (8,104 osteosarcomas, 6,476 chondrosarcomas, and 3,225 Ewing's sarcomas). The relative 5-year survival rate was 53.

Diagnostic pitfalls associated with fine-needle aspiration biopsy in a patient with the myxoid variant of monophasic fibrous synovial sarcoma.

Synovial sarcoma (SS) is one of the most common soft tissue tumors that typically presents in the extremities of young adults, but may occur at any site and affect children during the first decade. Herein we discuss a 12-yr-old male who complained of left foot pain and plantar mass. A fine-needle aspiration biopsy of an 8 cm subcutaneous mass was performed revealing a myxoid spindle cell neoplasm.

Diffuse pigmented villonodular synovitis: preliminary results with intralesional resection and p32 synoviorthesis.

Because of the high local recurrence rate associated with surgical resection alone, patients with diffuse intraarticular pigmented villonodular synovitis were treated with surgical resection followed by colloidal chromic P32 synoviorthesis. The medical records of nine consecutive patients treated in this manner were reviewed retrospectively to determine the recurrence rate of pigmented villonodular synovitis. All patients had either one or two surgical resections (arthroscopy in one patient, open resection in seven, arthroscopy and open resection in one).

Potential sampling error in fine needle aspiration biopsy of dedifferentiated chondrosarcoma: a report of 4 cases.

Background: Dedifferentiated chondrosarcoma is a rare, poorly understood and often fatal sarcoma that usually manifests as a high grade, non-cartilage-producing sarcoma juxtaposed against a low grade chondrosarcoma. A correct diagnosis requires recognition of both components. In the absence of complete resection, rendering a specific diagnosis on small biopsy specimens, such as fine needle aspiration biopsy (FNAB), may be extraordinarily difficult.

Human leukocyte antigen sensitization after structural cortical allograft implantations.

Unlabelled: The incidence and significance of a donor-specific human leukocyte antigen antibody response to massive fresh-frozen human bone allograft implantation is not established. This study was a prospective, multicenter study of a cohort of consecutive patients who self-randomized themselves into two groups based on their alloantibody response to allograft bone transplant. The study hypothesis was that donor-directed antibodies are an independent risk factor influencing incorporation of massive frozen bone allografts.

Soft-tissue lumps and bumps.

Soft-tissue masses of the extremities and torso are a common problem encountered by the orthopaedic surgeon. Although these soft-tissue masses are often benign, the orthopaedic surgeon must be able to recognize the features key to differentiating benign and malignant masses. An understanding of the epidemiology and clinical presentation of soft-tissue masses is needed in order to outline a practical approach to evaluation and surgical management.

Custom cross-pin fixation of 32 tumor endoprostheses stems.

The main cause of mechanical failure of primary and revision cemented tumor endoprosthetic stems is aseptic loosening. The placement of custom designed pins through the bone, the cement, and the stem can create a bone-cement-prosthesis composite that resists the rotatory stresses that lead to aseptic loosening. At risk situations include large primary reconstructions where the residual short metaphyseal articular segments lack sufficient length and cortical contact to provide lasting fixation, and revision prostheses that are to be recemented into straight diaphyseal segments that already have experienced aseptic loosening.

Endoprosthetic reconstructions for bone metastases.

The purpose of the current study was to help define the role that endoprosthetic reconstructions have in the treatment of metastatic bone disease. Of the 522 endoprostheses implanted at the University of California at Los Angeles (UCLA) between December 1980 and January 2002, 37 (6.9%) were used in 37 patients with metastatic disease.