Procedures

Excision of Tumor and Site Graft
Using Grafton® DBM Putty

William Parrish, M.D.
Assistant Professor of Orthopaedics and Rehabilitation
Milton S. Hershey Medical Center, Hershey, PA
The patient is a male in his early 40's 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.
A curette is used to thoroughly remove as much of the gross tumor as possible.
Copious amounts of phenol soluton are used to irrigate the site, and additionally applied with a cotton-tip applicator, effectively killing or lyzing any remaining tumor cells.
A broadblade electric cauterizer is also used to ensure complete eradication of tumor cells.
Several pieces of methylmethacrylate cement are placed into the cavity, separated by small pieces of latex glove to act as stress risers. Once cured, the cement is carefully chiseled out. After phenol irrigaton is again performed to remove cement residue and prevent infection, Grafton® DBM Putty is initially placed into the cavity with tweezers. Grafton® DBM Putty is packed into the cavity, using light thumb pressure and a tamp to gently pack it in place.
"The nice thing about Grafton® Putty is that there's not a lot you have to do to prepare it on the back table. It handles very nicely, has a dough-like consistency, compacts easily and stays where you want to place it. All you have to do is open up the jar and put it where you need it to be."

Dr. Willam Parrish
General Remarks
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 (allograft bone) is packed into the lesion in lieu of cement, providing both an osteoinductive and osteoconductive component to potentiate new bone growth.

Detailed Description
  • 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® 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® from shifting out of place.

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