okoj, Volume 8, No. 7

Foot and ankle amputations are most commonly performed for infection, ischemia, trauma, and neoplasm. A variety of amputation levels is available, depending on the specific pathology. Knowledge of the particular functional advantages and drawbacks surrounding the level of amputation, coupled with insight regarding tissue viability and perfusion status, facilitates optimal selection of a specific amputation procedure. Advances in the multidisciplinary fields of trauma and vascular surgery, as well prosthetics, rehabilitation, and patient management have combined to usher in a new perspective regarding foot and ankle amputation.

Named after its histologic resemblance to normal synovium, synovial sarcoma is a high-grade, malignant soft-tissue tumor that frequently occurs in the para-articular regions of the large joints of the extremities. Although it is often found in close association with tendon sheaths, bursae, and joint capsules, rarely does it involve the joint. Three distinct histologic subtypes have been described: biphasic, monophasic, and poorly differentiated. Synovial sarcoma accounts for approximately 8% of all soft-tissue sarcomas, and is most prevalent in adolescents and young adults 15 to 35 years of age. Wide surgical resection and adjuvant radiation therapy are the mainstays of treatment. Chemotherapy is also gaining a significant role. Five-year overall survival rates range from 36% to 76%. Tumor size greater than 5 cm, local invasion, metastases, and positive surgical margins have been shown to be negative prognostic factors.

Surgical site infections following spine surgery lead to increased morbidity, mortality, and increased utilization of surgical resources. Despite the multifactorial causes and relatively low incidence of such infections, patient safety initiatives have increasingly focused on whether surgical site infections are completely avoidable. This discussion addresses the key aspects of evaluation, risk factors, management, and strategies for preventing infections following spine surgery.