Excision of Tumor and Site Graft
Overview
This procedure involves complete removal of a giant cell tumor within the patient's dorsal radius. The resultant defect is cauterized and thoroughly irrigated with a concentrated phenol solution to eradicate any remaining tumor cells. Grafton DBM Putty is packed into the lesion in lieu of cement, providing both an osteoinductive and osteoconductive component to potentiate new bone growth.
Patient Background
The patient is a male in his early 40s who presented with wrist pain. He had a classic X-ray that showed geographic destruction of his distal radius and a subsequent diagnosis of giant cell tumor of bone. This was treated with an aggressive curettage and bone grafting technique using Grafton DBM Putty.
Procedure
- Using a dorsal approach to the wrist, a skin excision is carried deep into the extensor retinaculum between the third and fourth dorsal compartments. The tendons are displaced, exposing the distal radius.
- A 15-blade scalpel is used to incise the cortex, exposing the medullary cavity. A tumor material specimen is removed and sent to pathology for a frozen section analysis.
- A curette is used to thoroughly remove as much of the gross tumor as possible. The cavity walls are then extensively burred for further tumor cell removal.
- The inside of the cavity is thoroughly irrigated with a high concentration of phenol to kill or lyze remaining tumor cells.
- A broadblade electric cauterizer is used to kill any residual tumor. Phenol irrigation using a bulb syringe and application using a sterile cotton-tipped applicator are performed once again.
- A final burring with a sterile bur tip and subsequent phenolization procedure are completed.
- Several small pieces of methylmethacrylate cement are packed into the cavity, separated by pieces of latex glove to create stress risers and to aid in the removal of the cement.
- Once cured, the cement is carefully chiseled out, and the cavity is thoroughly irrigated to remove any residue and help prevent infection.
- Grafton DBM Putty is gently placed within the distal radius cavity, using light thumb pressure to pack it in place.
- The Grafton DBM Putty is tapped lightly with a tamp to ensure proper compaction into all areas of the distal cavity.
- It is important not to pack the Grafton DBM Putty too tightly. Doing so may inhibit in growth of blood vessels and slow the healing process.
- A final irrigation is performed, placing a thumb or digit over the grafted site to keep the Grafton DBM from shifting out of place.