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Beitragstitel Limb salvage over common amputation for very rare invasive carcinoma arising from chronic osteomyelitis of the femur
Beitragscode P60
Autoren
  1. Adam Kratky Kantonsspital Baselland Vortragender
  2. Peter Ochsner
  3. Niels Willi Kantonsspital Baselland
  4. Andrej M. Nowakowski Kantonsspital Baselland
Präsentationsform Poster
Themengebiete
  • A07 - Spezialgebiet 2 | Infekte
Abstract Introduction
Chronic osteomyelitis (COM) is a difficult to treat and recurring osseous infection caused mostly by contagious inoculation after open fracture injuries. A draining sinus tract is a frequent clinical sign with long-term persistence irritating the soft tissue, especially the skin. A malignant transformation of the sinus tract into a squamous cell carcinoma (SCC) is a very rare severe complication ranging from 0.2-1.6%. In such a case, amputation was commonly the treatment of choice on the limbs due to its potential for local invasion, metastatic spread, and recurrence.

Methods
We present a case of a male patient with a 36-year history of a sinus tract draining the COM of the right femur. A local invasive SCC had developed and the patient underwent a wide soft and bone tissue resection followed by a cement augmented plate osteosynthesis as a bone substitution preserving the function of the limb. Additionally, we reviewed the literature on surgical limb-saving therapy in SCC associated with COM and searched for analogies with our report in the discussion.

Results
Through the complex resection, both the COM and SCC have been cured. Antibiotics were given for 8 weeks after the surgery. The clinical examination showed proper wound healing and a weakened knee extension which improved partially during the years and was balanced with an orthotic brace. There was no evidence of either disease during 17 years. To our knowledge, the longest tumor-free follow-up ever published.
In the literature, 23 cases receiving the wide tumor resection were identified. Out of these cases, 10 had documented follow-up control with a mean time interval of 4.6 years (0.5 - 12.25). Only one local recurrence has been noted and resulted in below-knee amputation.

Conclusion
Based on our experience and recent literature review, the limb salvage treatment of the concomitant SCC in patients with COM should be taken into consideration in selected cases. The factors such as early diagnosis with no local or distant tumor spreading, low histopathological profile, no joint involvement, and functional potential after surgery should be present.