BACKGROUND: Isolated limb perfusion (ILP) is a well-established surgical procedure for the administration of high dose chemotherapy to a limb for the treatment of advanced extremity malignancy. Although the technique of ILP was first described over 60 years ago, ILP is utilised in relatively few specialist centres, co-located with tertiary or quaternary cancer centres. The combination of high dose cytotoxic chemotherapy and the cytokine tumour necrosis factor alpha (TNFα), mandates leakage monitoring to prevent potentially serious systemic toxicity. Since the procedure is performed at relatively few specialist centres, an ILP working group was formed with the aim of producing technical consensus guidelines for the procedure to streamline practice and to provide guidance for new centres commencing the technique.
METHODS: Between October 2021 and October 2023 a series of face to face online and hybrid meetings were held in which a modified Delphi process was used to develop a unified consensus document. After each meeting the document was modified and recirculated and then rediscussed at subsequent meeting until a greater than 90% consensus was achieved in all recommendations.
RESULTS: The completed consensus document comprised 23 topics in which greater than 90% consensus was achieved, with 83% of recommendations having 100% consensus across all members of the working group. The consensus recommendations covered all areas of the surgical procedure including pre-operative assessment, drug dosing and administration, perfusion parameters, hyperthermia, leakage monitoring and theatre logistics, practical surgical strategies and also post-operative care, response evaluation and staff training.
CONCLUSIONS: We present the first joint expert-based consensus statement with respect to the technical aspects of ILP that can serve as a reference point for both existing and new centres in providing ILP.

Based on the NCCN Guidelines for Soft Tissue Sarcoma (STS), treatment of extremity STS (ESTS) includes radiation therapy (RT) and surgical resection for tumors that are high-grade and >5 cm. ​​The aim of this study was to describe the association between neighborhood socioeconomic status (nSES), concordance with NCCN Guidelines recommendations, and outcomes in patients with ESTS.
Patients with ESTS diagnosed from 2006 through 2018 were identified in SEER registries. The analytic cohort was restricted to patients with high-grade tumors >5 cm without nodal or distant metastases who received limb-sparing surgery. Patient demographics and tumor characteristics associated with receipt of RT were analyzed using adjusted regression analyses. Kaplan-Meier curves and adjusted accelerated failure time models were used to examine disparities in cancer-specific survival.
Of 2,249 patients, 29.0% (n=648) received neoadjuvant RT, 49.7% (n=1,111) received adjuvant or intraoperative RT, and 21.3% (n=476) did not receive RT. In adjusted analyses, lower nSES was associated with lower likelihood of receiving RT (odds ratio, 0.70 [95% CI, 0.57-0.87]; P<.001). Low nSES was associated with worse cancer-specific survival (hazard ratio, 1.19 [95% CI, 1.01-1.40]; P=.04). Race and ethnicity were not significant predictors of receipt of RT or cancer-specific survival in the fully adjusted models.
Patients from lower nSES areas were less likely to receive NCCN Guideline-recommended RT for their ESTS and had worse cancer-specific survival. Efforts to better define and resolve disparities in the treatment and survival of patients with ESTS are warranted.

Major extremity fractures are serious limb injuries often including notable soft-tissue injury with possible injuries to the head, chest, or abdomen. High-energy traumatic fractures carry a high risk of surgical site infections even with use of systemic antibiotics and techniques in risk reduction. The American Academy of Orthopaedic Surgeons released a clinical practice guideline in 2023 based on current literature on the prevention of surgical site infections after major extremity trauma. The case presented in this article is an example to demonstrate the clinical application of these guidelines.

After studying this article, the participant should be able to: 1. Understand and describe the basic principles underlying the intrinsic versus extrinsic proposed mechanisms for the development of amniotic band syndrome (ABS). 2. Discuss risk factors and conditions that are associated with the development of ABS. 3. Understand the various presentations and associated clinical implications of ABS by anatomic location. 4. Describe the basic tenets underlying various repair technique options for ABS of the extremities. 5. Discuss the common manifestations of ABS in the face and trunk. 6. Understand clinical implications of fetoscopic surgery as it relates to ABS treatment as a novel method for limb salvage in utero.
Amniotic band syndrome (ABS) refers to the development of constrictive bands of fibrotic tissue in utero. It can lead to a variety of clinical manifestations after delivery. There is much debate in the plastic surgery community regarding the exact pathophysiologic mechanism for the development of ABS, and the most appropriate management. This CME article aims to provide an overview of ABS manifestations throughout the body, and to expound on the most recent advances in anticipatory and definitive management of the condition.

Soft tissue sarcomas are rare, heterogeneous tumors that are frequently in the extremities. Treatment includes surgical resection, combination chemotherapy and/or radiotherapy, as well as supplementary procedures such as isolated limb perfusion and regional deep hyperthermia. The prognosis depends on the tumor stage and the approximately 70 histological subtypes, with specific treatment approaches existing only for some subtypes. This review summarizes the recommendations of the German S3 guideline \"Adult Soft Tissue Sarcomas\" and the European Society for Medical Oncology (ESMO) guideline \"Soft tissue and visceral sarcomas\" regarding the diagnostic workup and therapy of soft tissue sarcomas of the extremities.
UNASSIGNED: Weichgewebesarkome sind seltene, heterogene Tumore, welche häufig an den Extremitäten lokalisiert sind. Die Therapie beinhaltet die chirurgische Resektion, Kombinationschemotherapie und/oder Strahlentherapie sowie ergänzende Verfahren wie isolierte Extremitätenperfusion und regionale Tiefenhyperthermie. Die Prognose ist abhängig vom Tumorstadium und den etwa 70 histologischen Subtypen, wobei nur für einige Subtypen spezifische Therapieansätze existieren. Diese Übersichtsarbeit fasst die Empfehlungen der deutschen S3-Leitlinie „Adulte Weichgewebesarkome“ und der Leitlinie der European Society for Medical Oncology (ESMO) „Soft tissue and visceral sarcomas“ zur Diagnostik und Therapie lokalisierter Weichgewebesarkome der Extremitäten zusammen.

暂无摘要。

Prevention of Surgical Site Infections After Major Extremity Trauma Evidence-Based Clinical Practice Guideline is based on a systematic review of current scientific and clinical research. This clinical practice guideline (CPG) is designed to assist qualified physicians and clinicians when making treatment decisions for adults (18 years or older) who have sustained major extremity trauma. The CPG workgroup defined major extremity trauma as an open fracture, a major/high-energy closed fracture, a degloving injury, Morel-Lavallée lesions, a low-energy or high-energy gunshot injury, a crush injury, a blast injury, or any other moderate-energy to high-energy injury. This guideline contains 14 recommendations that evaluate preoperative, perioperative, and postoperative interventions to limit the risk of surgical site infections after major extremity trauma while also identifying and evaluating potential patient-specific risk factors to consider. Another six options formulated with either low-quality evidence, no evidence, or conflicting evidence are also presented and discussed in the CPG. These include the use of incisional negative-pressure wound therapy for high-risk surgical incisions, the implementation of an orthoplastic team, the possible role of hyperbaric O2, the value of various preoperative skin preparations, and select modifiable and administrative risk factors.

Background: Open fractures, defined as fractures communicating with the environment through a skin wound, cause substantial morbidity after traumatic injury. Current evidence supports administration of prophylactic systemic antibiotic agents to patients with open extremity fractures to decrease infectious complications. Methods: The Therapeutic and Guidelines Committee of The Surgical Infection Society convened to revise guidelines for antibiotic use in open fractures. PubMed was queried for pertinent studies. Evaluation of the published evidence was performed using the GRADE framework. All committee members voted to accept or reject each recommendation. Results: In type I or II open extremity fractures, we recommend against administration of extended-spectrum antibiotic coverage compared with gram-positive coverage alone to decrease infections complications, hospital length of stay or mortality. In type III open extremity fractures, we recommend antibiotic therapy for no more than 24 hrs after injury, in the absence of clinical signs of active infection, to decrease infectious complications, hospital length of stay or mortality, and we recommend against extended antimicrobial coverage beyond gram-positive organisms to decrease infectious complications, hospital length of stay or mortality. In type III open extremity fractures with associated bone loss, we recommend antibiotic therapy in addition to systemic therapy to decrease infectious complications. Conclusions: Although antibiotic agents remain a standard of care for infection prevention after open extremity fractures, our findings and surveys of clinical practice patterns clearly show that additional robust clinical trials are needed to provide stronger corroborating evidence.

The American Academy of Orthopaedic Surgeons Clinical Practice Guideline \"Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery\" is a summary of the available literature designed to help guide surgeons provide a safe and effective means of pain alleviation for orthopaedic surgery patients. The following case study demonstrates these guidelines at work in a patient undergoing total shoulder arthroplasty. The recommendations listed in the following sentences are from the Clinical Practice Guideline. Preoperative patient education regarding the effects of opioids and benefits of early termination may help patients discontinue opioids earlier in their postoperative course. Perioperative use of intravenous ketamine and regional anesthesia continuous peripheral nerve catheters help reduce pain scores and decrease opioid use. Postoperative cryotherapy may provide a modest benefit in reducing pain scores. Postoperative cyclooxygenase-2 selective nonsteroidal anti-inflammatory medications (NSAIDs) and oral acetaminophen improve pain and decrease opioid use. Combination opioid/NSAIDs may provide a modest improvement in pain scores at the expense of NSAID dose optimization in the postoperative period. Gabapentin has not been shown to improve patient outcomes; however, pregabalin may decrease pain and opioid use after total joint arthroplasty.

Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery Clinical Practice Guideline is based on a systematic review of current scientific and clinical research. The purpose of this clinical practice guideline is to evaluate therapeutic interventions to alleviate pain, improve function, and reduce opioid use after musculoskeletal injury or orthopaedic surgery by providing 29 evidence-based treatment recommendations to be used by orthopaedic surgeons and other clinicians. In addition, the work group highlighted the need for better research to help patients recovering from injury or surgery experience safe and effective pain alleviation.