Guidelines for Complications of Cancer Treatment Vol VIII Part B

local tumor and to preserve as much as possible of the normalsoft tissue, thus providing a well-functioning, tumor-free, andpainless limb. The modern imaging techniques clearlydemonstrate the local extent of tumor and permit a guide for asafe level of wide resection. A successfully salvaged limb inthe well-selected patients can improve pscyche, simplify therehabilitation process and preserve intact body image. Thedistal femur and proximal tibia are the common sites of themalignant bone neoplasms. Thus many options of limb salvageoperation around the knee have been developed, includingresection-arthrodesis of knee joint, reconstruction of the kneeusing bone graft (autograft, allograft, allograft/endoprostheticcomposite), endoprosthesis reconstruction, Ilizarov leglengthening technique, rotationplasty. The selection of a properprocedure is determined on individual basis. Thehistopathological diagnosis/grading, tumor extent, presenceof lung metastasis, local involvement, patient’s age, life andwork needs, etc. all may influence the choice of any limb salvageprocedure.Compared with the allograft and autograft reconstructionoptions, the endoprosthesis reconstruction of limb after wideresection of malignant tumor avoids the problems of diseasetransmission and limited source of supply that may beencountered in autograft or allograft reconstructions and inpediatric patients. Tumor endoprostheses can provide a wideavailable range of size and custom design to fit the needs ofeach patient. Many design principles and concepts have beenevolved from clinical experience in the recent three decades toimprove the function and decrease the complications. Thusthe endoprosthetic reconstruction becomes an alternative toallograft or autograft in the limb salvage procedures and hasbecome more and more common recently. We also havedesigned our own custom-made tumor endoprosthesis forreconstruction in the limb salvage procedures since 2000.99