Extended Curettage

What is Extended Curettage ?

  • Curettage is the process of entering a tumour and clearing its contents.
  • Extended curettage is the process of extending the clearance using a high speed burr (beyond the borders of tumour to clear microscopic debris)
  • Reconstruction of the defect is then carried out by various methods.

What are indications for Extended curettage?

 How is extended curettage performed?

  • Incision depends on location of tumour and biopsy scar or previous surgery.
  • Biopsy scars are excised during the incision.
  • A tourniquet is almost always used in case of extremities or limbs.
  • This enables the surgeon to operate in a near bloodless field.
  • Also the risk of bleeding is negligible during surgery.
  • The tourniquet is then removed post procedure.
  • A “Window” of sufficient size is created on the affected site of bone.
  • A “Curette” is used to clear macroscopic tumor tissues from the host bone.
  • Periodic regular saline wash and hydrogen peroxide wash is given to flush out tumour debris.
  • Small pockets of tumor are cleared with help of “High speed Burr”, which can clear microscopic tumor tissues.
  • The recommended clearance is 2-3 mm or until healthy normal bone is visualized.
  • The periosteum layer of bone is cleared of any tumor tissues.
  • Adjuvants are often used to help clear the tumor and kills the tumour cells.
    • Hydrogen peroxide
    • Absolute alcohol, phenol (85%)
    • Liquid nitrogen.
    • Argon Plasma Cautery (APC)

  • The walls of curetted host bone are then burnt or Cauterized with Monopolar cautery or APC.

How is Reconstruction performed ?

Depends on the following factors

    • Type of Bone Involved
    • Location (Epiphysis, Metaphysis or Diaphysis)
    • Age
    • Size and Shape of Defect
    • Expectant functional return of patient following counselling
    • How close the tumour is to the joint cartilage

  • Different Reconstruction Options are as follows
    • Cement (PMMA or polymethylmethacrylate)
      • Ideal filler after curettage of benign bone tumors with high risk of local recurrence.
      • Also acts as tumoricidal (kills tumor cells) due to thermogenic (production of heat) effect.
      • Ideally suited for cavities which have good host bone stock available.
      • An advantage of using cement over bone graft is that recurrence is easily identifiable.

    • Bone graft
      • Bone grafts are used for reconstructing a defect when the bone stock is less or the host bone needs structural support.
      • Different types of bone grafts can be utilized to reconstruct the cavity/ defect, such as autograft, allograft in the form of cancellous bone chips or strut grafts.
      • The advantage with utilizing bone graft is that remodeling occurs leaving host bone residue.
      • Autograft (Harvested from Patients own body).
        • Autogenous bone is preferred if a rapid and extensive bone growth is required, but has the disadvantage of another procedure to harvest.
      • Allograft (Harvested from Healthy donor & Processed).
        • Allogeneic bone grafts are utilized more commonly as struts or block fillers providing structural integrity.
      • Combination of Autograft & Allograft
      • Bone graft substitutes

    • Osteosynthesis (Use of Plate or Screws or Nail or combination)
  • A suction drain is inserted into the cavity to drain and clear any post- operative fluid collection.
  • Postoperative rehabilitation depends on the bone involved, size and reconstruction of defects.
  • Average duration of stay in hospital will be 3-4 days.
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  • Apollo Cancer Center
    Apollo Hospitals, Bengaluru
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