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KMID : 0613320000060020113
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Journal of the Korean Bone and Joint Tumor Soceity
2000 Volume.6 No. 2 p.113 ~ p.124
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Treatment of Infection after Prosthetic Reconstruction in Limb Salvage Surgery
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Kim Han-Soo
Oh Joo-Han
Lee Sang-Hoon
Lee Han-Koo
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Abstract
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Purpose : Infection is one of the worst complication after limb-salvage surgery of bone and soft tissue tumors, and we report the experience of 18 cases to discuss the treatment protocol of infection after using tumor prosthesis.
Materials and Methods : Eighteen cases (12.4%) of infection developed out of 145 patients undergone limb-salvage surgery from 1985 to 1998. The diagnosis of primary tumor was osteosarcoma (14), chondrosarcoma (3) and giant cell tumor (1). Average age at the operation was 22.4 years (ranging from 7 to 63). The tumors were located at the distal femur or proximal tibia in 12 limbs. Fourteen patients received chemotherapy. Pathogenic organisms were identified in 15 cases, thirteen of them were Staphylococcus species. The treatment options included antibiotics, debridement, flap surgery, revision, arthrodesis and amputation.
Results : Infections were controlled successfully in 5 limbs with debridement only and 2 limbs with two stage revision. Arthrodeses were performed in 3 limbs and amputations in 2 limbs. Infection was suppressed, not cured, in 6 cases with antibiotics. Late pulmonary metastasis developed in 4 out of 10 cases in which chemotherapy was delayed or interrupted by infection. The prognosis was poor in case of delayed debridement over 2 weeks, cementless fixation of prostheses and soft tissue defects (p＜0.01).
Conclusion : Infection after limb-salvage surgery is not only difficult to treat, but has bad influence on the patient’s prognosis because of delay or interruption of scheduled chemotherapy. Preventive procedures such as soft tissue coverage and aggressive, prompt management of infection will be mandatory.
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KEYWORD
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Infection, Tumor prosthesis, Treatment protocol
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