Hemicortical excision for low-grade selected surface sarcomas of bone

In malignant surface tumors, hemicortical excision in select cases may allow adequate margins with better function. We treated 10 of 22 malignant surface tumors with hemicortical excision and reconstruction from January 2000 to June 2003. There were eight conventional parosteal osteosarcomas, one high-grade surface osteosarcoma, and one surface chondrosarcoma. Six tumors occurred in the femur, two in the tibia and one each in the humerus and radius. Defects were reconstructed with allograft (five), fibula autograft (three), or autogenous iliac crest (two). Internal fixation as suitable was used. Margins were reported uninvolved in all cases. At followup ranging from 40 months to 61 months we observed no local recurrence. Using the MSTS scoring system, six patients had a maximum possible score of 30; the other four had a score of 29. None developed distant metastasis. Though a longer followup is ideal, in selected cases hemicortical excision appears a reasonable procedure that obviates joint replacement. Biological reconstruction with bone could help reduce the incidence of subsequent revision surgery that would likely occur in cases treated initially with conventional excision and replacement with megaprostheses or circumferential intercalary allografts.