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Comparative study between different methods of

Recycling of resected bone tumor segment


In treatment of malignant bone tumors

Essay

Submitted for partial fulfillment of master degree in


Orthopedic surgery

By

Ashraf Yassin Abdel Azim


M.B.B.Ch

Under supervision of

Prof. Dr. Sameh Shalaby


Prof. of orthopedic surgery
Faculty of medicine
Ain shams university

Dr. Mohammed Abdel Rahman Mostafa


Assistant professor of orthopedic surgery
Faculty of medicine
Ain Shams University

Faculty of medicine
Ain Shams University
2007
Content

¾ Introduction.
¾ heating.
ƒ Autoclaving :
o Technique
o Advantages
o disadvantages
ƒ Pasteurization
o Technique
o Advantages
o disadvantages
ƒ Microwave induced hyperthermia
o Technique
o Advantages
o disadvantages
¾ Pasteurization.
Technique
Advantages
Disadvantages
¾ Freezing using liquid nitrogen.
Technique
Advantages
Disadvantages
¾ Extracorporeal irradiation
Technique
Advantages
Disadvantages
¾ References.
¾ English summary
¾ Arabic summary
Introduction

Because of the advances in diagnostic imaging, neoadjuvant


chemotherapy and operative technique limb salvage surgery is now
replacing amputation for treatment of malignant bone tumors.
Studies proved that limb salvage has the same outcome of the
ablative surgery (Manabe 2002).

Allografting is a commonly used procedure but has its drawbacks


such as immunological reactions, disease transmission, social and
religious dissatisfaction in some regions of the world.

Immediate reimplantation of the resected bone in surgical


treatment of cancer can be done after extracorporeal treatment such
as heating, freezing or irradiation to devitalize the tumor infiltrated
segment.

Heating is the simplest procedure involving boiling, autoclaving


and pasteurization which has upper hand as boiling and
autoclaving shows delayed remodeling (Adel Rifaat2003).

Irradiation as a method for extracorporeal recycling of resected


bone tumor segment was started since 1950 by cathode ray on
cadaver bone by Bassett et al. and since this time irradiation
treatment evolved (Paul Bohm2002).

Freezing by use of liquid nitrogen is recently used for


reconstruction in patient with bone and soft tissue tumor as heating
cause weakness and high vulnerability of infection and it is
relatively easy (Sakayama2006).
Aim of Essay

Is to give information about different methods of recycling as one


of methods of limb salvage in treatment of bone tumors regarding
the technique, advantage and disadvantage for each method. And
also to choose the most suitable method for Egyptians regarding
cost and benefits
Reference:

1) Paul Bohm and Jorg Stihler :


Intraosseous temperature during autoclaving.
J Bone Joint Surg [Br] l995;77-B:649-53.

2) Jun Manabe, Adel Rifaat Ahmed et al.


Pasteurized autologous bone graft in surgery for bone and soft
tissue sarcoma.
Clin orthop (2004) 419: 258-266.

3) Norio Yamamoto, Hiroyuki Tsuchiya and Katsuro Tomita


Effect of liquid nitrogen treatment on the proliferation of
osteosarcoma and the biomechanical properties of normal bone.
J Orthop Sci (2003) 8:374–380

4) Kenshi Sakayama et al.


pathological findings of an autograft containing osteosarcoma
treated by liquid nitrogen retrieved 2 years after implantation.
J Orthop Sci (2006) 11:655–656

5) Paul Bohm, Jurgen Fritz et al


Reimplantation of extracorporeal irradiated bone segments in
musculoskeletal tumor surgery : clinical experience in eight
patients and review of the literature.
Langenbecks Arch Surg (2003) 387:355–365

6) Shinobu Takahashi et al.


Case report : en bloc resection, extracorporeal irradiation and
reimplantation of entire tibia.
J Orthop Sci (2006) 11:298–302

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