Salvage Resolution in Sequence of Limb Salvage Surgery:
Hyperbaric Oxygen Adjuvant in Musculoskeletal Oncology
Sutipat Pairojboriboon MD1, Phutsapong Srisawat MD1, Thipachart Punyaratabandhu MD1,
Thanawat Supanitayanon MD2, Puwadon Veerapan MD1, Supichai Charoenvareekul MD1
Affiliation :
1 Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
2 Division of Underwater and Aviation Medicine, Naval Medical Department, Somdejprapinklao Hospital, Bangkok, Thailand
Background : For most sarcoma patients, limb sparing surgery is the standard of care. However, these salvage procedures may
potentially result in complications such as post-operative wound problems owing to the reconstruction processes leading to
dif(cid:976)iculty in resolving and (cid:976)inding a suitable solution.
Objective : To report the cases and outcome after using a new treatment modality of hyperbaric oxygen therapy [HBO2T].
Case Report : Four cases show the outcome after using HBO2T in sequence of limb salvage surgery between December 2008 and
December 2015 with evidence-based support. These cases had four different types of predictive major complication, 1) compromised
(cid:976)lap with sign of necrosis subsequently attempting coverage after wide resection of the high grade spindle cell sarcoma on the
knee, 2) chronic refractory osteomyelitis after wide excision and allograft reconstruction of osteosarcoma of the proximal tibia, 3)
soft tissue necrosis subsequent to re-excision of previously irradiated recurrent myxo(cid:976)ibrosarcoma, and 4) radiation injury of the
cutaneous wound after wide resection and postoperative radiation after refractory wound dehiscence occurring in pleomorphic
leiomyosarcoma left lateral ankle.
Results : Compromised (cid:976)lap after treating with HBO2T application for 20 sessions, recovery of the viable tissues were achieved.
Osteomyelitis after allograft reconstruction, infection was subsided then knee fusion was performed afterward. Healing enhancement
in resected wound with previously irradiated area. Wound dehiscence was closed in postoperative radiation.
Conclusion : HBO2T can be considered as an adjuvant therapy for problem cases in salvage resolution in sequence of limb salvage
surgery and bene(cid:976)icial to enhance wound healing.
Keywords : Hyperbaric oxygen therapy, Chronic osteomyelitis, Compromised (cid:976)lap, Wound, Radiation injury, Salvage, Allograft
infection, Sarcoma
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