Orthopaedic Oncology and Complex Reconstruction

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Causes of Pelvic Malformations
The two most common causes of pelvic malformations include removal of pelvic tumors and prostheses around the pelvis. The causes and consequences of these two problems can be very different, but they are the same. A systematic and thorough approach is required to achieve a surgical plan. In some cases, very
Similar surgical techniques are needed to treat bony defects.
Primary tumor
The pelvis is a common site (10%) for the development of primary tumors. The most common base basin Tumors include chondrosarcoma, Ewing's sarcoma, and osteosarcoma (1). Primary malignancies can be treated with curative intent If systemic spread has occurred, the primary focus of pelvic surgery is local control
of the disease. The principle of tumor resection is to obtain a large surgical margin over a defined distance
B. At least 2 cm of transparent bone in the bone line and a cuff of normal tissue which is designated anatomic tissue Layer like muscle or fascia parallel to the bony cortex (2). Surgery can be associated neoadjuvant chemotherapy or radiotherapy. The extent of the wide margins determines the amount of bone
Loss and subsequent reconstruction. In addition, the inclusion of soft tissue in the hoop frame can help complexity by increasing dead space and compromising secure wound closure. 
Secondary Tumors
Bone metastases occur in almost 60% of carcinomas (3). The pelvis is one of the most common sites for metastases with breast, lung, prostate, kidney, and thyroid carcinoma being the primary sources (3). With the exception of renal carcinoma, most metastatic bone tumors are permeative, poorly circumscribed, sclerotic, lytic or mixed, and not associated with a large soft tissue component. In contrast, renal carcinoma metastases are characterized by large cannon-ball-like lesions which are profoundly lytic and associated with a large soft tissue component and hypervascularity.  Unlike primary bone malignancies which are solitary and are treatable by wide surgical margins, metastatic disease is conventionally treated with bone-conserving procedures such as curettage or the removal of only macroscopically affected tissue. This is because true solitary metastases are uncommon with the high likelihood that there are micrometastatic lesions within the same bone at the time of diagnosis. In light of this, bone metastasis should be regarded as a locally progressive disease with the expectation that despite surgical intervention, recurrence of disease will occur. Peri prosthetic recurrence of tumor may rapidly lead to failure of the device; therefore, reconstructions should aim for maximum durability in the setting of ongoing bone loss and a shortened patient survival. For example, the entire length of tubular and flat bones should be spanned when considering internal fixation to avoid fracture through unprotected bone distal to a fixation device. The
judicious use of cement as filler or to supplement fixation should be encouraged rather than relying solely on individual screws which are easily loosened by tumor progression. Cemented prosthetic fixation is preferred when considering hip arthroplasty for the same reason.  Primary pelvic tumors are characterized by late presentation. The capacious volume of the pelvis or the abundant fat and muscle around the pelvic girdle frequently masks the presence and development of pelvic
tumors until they have reached enormous sizes. Soft tissue sarcomas are frequently painless as compared to bone malignancies which often cause painful symptoms. These later symptoms, however, are often vague and can be misinterpreted as musculoskeletal injury or as pain referred from the lumbar spine. Soft tissue tumors in the pelvis are often the result of a compressive effect on adjacent internal organs. Large tumor sizes often distort normal anatomy and displacement and can make dissection difficult. Major neurovascular structures of internal organs and known pathways. Big basics Pelvic tumors that require a large excision margin can be complicated by the need for biological protection.
Neurovascular structure located within the year of resection, for example, the yochonchu nerve trunk, It can be compressed, passing under and in front of the sides of the sacral towards the sciatic fissure. Tumors that occur in the ceiling joint or are susceptible to infection when affected In the case of colorectal osteosarcoma, the excised cartilage passes through the sacral foot. Tumors that overhang the sciatic notch may obscure the passage of the sciatic nerve and the branches of the internal iliac vessels as they traverse the notch, making them vulnerable to injury. Tumors of the anterior pelvis may compress the bladder, or obstruct the superficial femoral artery and vein or the femoral nerve as these structures course across the superior pubic ramus. Structures which are held to the pelvis by fascia such as the lumbosacral nerve trunk or the femoral vessels and nerve are particularly vulnerable to tumor compression or iatrogenic trauma. 

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