Introduction: Acral sarcomas present as small tumours to specialised orthopaedic services. There is a high incidence of inadequate resection compromising clinical and functional outcome.

It is advised that lumps which are greater than 5cm should be referred to a sarcoma centre for management and that small lesions cause less harm with unplanned excision.

Method: Data from the Oxford Registry was collated of all those patients with acral sarcomas who underwent surgery in a period from 1997 – 2008 at The Nuffield Orthopaedic Centre including site, size, histological subtype, of tumours, history of previous surgical excisions, staging, and functional scores.

Results: 27 patients were treated (17 foot and ankle cases, 10 hand tumours). The commonest acral lesions were synovial sarcomas (30%).

Of the hand patients 7 of the 10 patients had wide excision of the lesion with 3 an amputation. 5 of the cases were for inadequate previous excision (50%).

7 of the 17 in the foot and ankle group underwent amputation (41%) the rest wide excision. 29% of cases were for second time surgery due to inadequate previous excision.

Discussion: Our study shows that up to 50% of patients with acral tumours are undergoing further surgery due to previous inadequate excision. The belief that 5cm should be a benchmark for specialist referral should not be applied to such lesions.

Purpose: To quantify the functional outcome of patients who were known to have sciatic nerve involvement pre-operatively and went on to have nerve preserving surgery utilising a planned marginal excision with epineurectomy.

Materials and Methods: Ten patients with large volume posterior thigh soft tissue sarcoma with known sciatic nerve involvement were reviewed between 1997 and 2004. Nine underwent surgery with extended epineurectomy of the sciatic nerve and planned marginal excision.

All patients underwent staging and follow up at Sarcoma Clinic with functional assessment and TESS evaluation.

Results: There were seven low and two high grade posterior thigh tumours of which nine were liposarcoma and 1 haemangiopericytoma. Two were recurrent and eight primary. There were five men and five women with a mean age of 77.

Nine patients underwent planned marginal excision. Sciatic nerve involvement was 13–30cm in eight cases and in one case the sciatic nerve was abutting the tumour throughout its length. There was soft tissue reconstruction in three cases using fascial adductor or gracilis graft for sciatic nerve cover and one with superficial femoral nerve and vein resection requiring ipsilateral saphenous reconstruction. The remainder underwent direct primary reconstruction.

Four patients underwent radiotherapy 46–60 Gy.

There was no local recurrence of disease within 14 – 96m follow-up. There was one patient with post radiation wound breakdown that resolved.

Three patients have died of unrelated causes. To date there has been no evidence of local recurrence of disease at FU.

Conclusion: Planned marginal excision of low grade large volume posterior thigh sarcomas with extensive sciatic nerve involvement can be successfully treated with preservation of the sciatic nerve without significant morbidity and resultant good limb function.

Aim: To describe the clinical, radiological and pathological features of this rare subtype of osteoblastoma diagnosed pre-operatively and treated by excision.

Conclusion: Toxic osteoblastoma is a benign bone forming tumour that presents with systemic symptoms of fever, anorexia and weight loss.

It has a characteristic radiographic appearance with marked periostitis in the involved bone mimicking osteosarcoma and associated focal abnormality in juxtaposed skeletal sites.

With the help of two previously reported cases from the literature of aggressive bone forming tumours in children who presented with marked anorexia and cachexia diagnosed as osteomyelitis and osteosarcoma and treated by ablative surgery this tumour was correctly diagnosed with planned subtotal scapulectomy and reconstruction enabling a good functional result. The systemic symptoms fully resolved following surgery with return of appetite and weight gain.