Extended Curettage

Extended curettage is a surgical procedure commonly used in the management of benign bone tumors, particularly giant cell tumors of bone (GCTB). It involves the removal of tumor tissue from the affected bone using a curette, along with additional measures to ensure thorough removal and reduce the risk of tumor recurrence. Here's a detailed description of extended curettage:

Surgical Technique:

• Access and Exposure: The surgical site is accessed through an appropriate incision, providing adequate exposure of the affected bone and tumor. Soft tissue structures such as muscles, tendons, and nerves are carefully retracted to ensure clear visualization of the tumor and surrounding bone.
• Tumor Removal: Using a sharp curette or similar instrument, the surgeon carefully removes the tumor tissue from within the affected bone. Extended curettage involves thorough scraping and scooping out of the tumor tissue from the bone cavity, ensuring complete removal while preserving the integrity of the surrounding healthy bone.
• Adjunctive Measures: To reduce the risk of tumor recurrence, adjunctive measures may be employed during extended curettage. This may include the use of chemical agents such as phenol or liquid nitrogen to destroy residual tumor cells and sterilize the bone cavity. Additionally, bone grafting or bone cement may be used to fill the void left after tumor removal, providing structural support and promoting bone healing.
• Reconstruction: In some cases, reconstruction of the bone defect may be necessary following tumor removal. This may involve the use of bone grafts, bone substitutes, or other reconstructive techniques to restore bone continuity and function.

Postoperative Care:

• After extended curettage, the patient undergoes close monitoring for signs of wound healing, infection, or tumor recurrence.
• Physical therapy and rehabilitation may be initiated to restore mobility, strength, and function to the affected limb, particularly if adjacent joints or muscles were involved in the surgical procedure.

Advantages:

• Preservation of Function: Extended curettage preserves the surrounding healthy bone and joint function, minimizing the risk of functional impairment compared to more aggressive surgical options.
• Reduced Morbidity: Compared to en bloc resection or amputation, extended curettage is associated with lower rates of postoperative complications and shorter recovery times.
• Lower Recurrence Rate: When performed meticulously and with adjunctive measures, extended curettage has been shown to achieve low rates of tumor recurrence, allowing for long-term disease control in many cases.