Introduction

Pneumatic tourniquets (PTs) are commonly used in local anaesthetic cases in the upper limb to provide a bloodless operating field. They give excellent efficacy however their limitations have prompted the introduction of a new single-use sterile silicone ring tourniquet (SRT). The evidence of use of the SRT over the standard PT is limited.

Introduction: Radical excision and amputation are the surgical options for advanced soft tissue tumours (STS) of the limbs. The sheer size of these advanced tumours in relation to the limb makes limb sparing surgery difficult. The rate of positive margins is high and further management options are quite limited.

Patients & Methods: We have identified 17 patients (13 males, 4 females) with sarcomas with skin changes at presentation, including recurrences and primary referrals. The average age was 67 (37–83) years. 11 patients had lower limb tumours and 6 had upper limb tumours. All patients were managed either with radical excision or amputation. Post op radiotherapy and chemotherapy was used s adjuvants when appropriate. All patients were followed up with regular clinical and radiological assessments for recurrences and metastases. The results of adequacy of clearance, recurrences, metastases and overall survival are presented.

Results: The follow-up was an average of 30 (7–120) months. Two patients had primary amputations and 15 had wide excision. Four patients had distant metastases at the time of referral. Positive margins were identified in 8 of the 17 patients after primary surgery. 5 patients had a single recurrence and 3 patients had two recurrences. Eight patients needed revision surgery (3 amputations/5 wider excisions) for a positive margin or a recurrence. A total of 8 patients had metastases by 1 year. Overall disease free survival in this cohort was 20 (3–41) months.

Conclusion: We encountered a very high rate of positive margins with high morbidity which seems quite common after limb sparing surgery in fungating STS. Amputation comparatively attains better local disease control but probably does not affect the overall survival.

Introduction: Limb schwannomas are benign nerve sheath tumours. They typically present with a cystic swelling or palpable lump. They may also present with symptoms relating to the affected nerve. If the lesion is solitary there is no malignant potential. Clinically the lump will be freely mobile except in the plane of the longitudinal course of the nerve and may have a positive Tinnel’s test. Magnetic resonance imaging or ultrasound scanning are key adjuncts to diagnosis. Treatment is excision of the lump by incising the epineurium, “shelling out” the lesion and preserving unaffected nerve fascicles. We present a case series from a regional soft tissue tumour centre that shows the excellent outcome that can be achieved with these methods.

Methods: We retrospectively analysed the case notes of 16 cases of schwannoma who had surgical excision and preservation of the parent nerve. Our outcome measures were resolution of symptoms, post-operative neurological function and recurrence.

Results: Of 16 patients, 12 had no neurological deficit. 1 had motor weakness (foot drop) and 1 had residual par-aesthesia post-operatively. 2 patients declined surgery. In addition, 2 patients had persistent pain post-operatively, but at reduced levels to their pre-operative pain. There were no cases of recurrence.

Discussion: The diagnosis of schwannoma should be considered in patients with a lump associated with neurological symptoms. Following confirmation of diagnosis with appropriate radiology, surgical excision should be carried out as detailed above to minimise morbidity. This should be performed by a surgeon skilled in dealing with soft tissue tumours.

Introduction: PVNS is a benign proliferative disorder of the synovium presenting as local or diffuse variants. The condition commonly involves the knee with a slow and indolent progress.

Case series:

Presented with anterior knee pain. Examination revealed supra-patellar fullness and tenderness. MRI scan showed a suspicious soft tissue tumour. Histology confirmed PVNS after excision biopsy.

Conclusion: This case series aims to highlight the complexities in diagnosing PVNS. It should be a differential diagnosis of any kind of soft tissue problem especially around the knee. Immunohistochemistry may be useful. Multiple recurrences is a problem; adjuvant therapy may be indicated in resistant cases.