Electrocautery inactivation of giant cell tumor of bone after curettage

  The principle of current cautery for residual cavity treatment is to heat the tissue through the high-frequency high-voltage current from the electrode tip in contact with the muscle to achieve high local tissue temperature and kill the residual cavity tumor. There are various ways of electric current cautery, including ordinary high frequency electric knife cautery, argon knife cautery and so on. The argon ions produced by argon knife can continuously transfer the coagulation current output from electrode to the area around the electrodebrider head to produce good thermal effect to achieve the effect of inactivation, so in theory, argon knife has more advantages than ordinary high frequency electrodebrider. During the operation, the tumor remnant cavity is continuously cauterized until the entire remnant cavity appears to be significantly carbonized. The high temperature of the cautery process leads to tissue coagulation, which further causes tissue vaporization and carbonization.  Electrocautery treatment of tumors is often used as a palliative treatment for unresectable tumors or metastatic lesions in gynecologic and abdominal surgery. High-frequency electrical energy causes tissue dryness, coagulation and contraction, which further leads to vaporization and carbonization. Intraoperative results can be significantly increased when used in combination with an argon beam. The argon knife is typically set at 100 watts and can be used for more than 10 seconds per site to a depth of 2.4 mm.  The advantages of using the electrodebrider to treat the tumor remnant cavity are its convenience and ease of use, avoiding the risk of chemical burns and systemic toxicity that may result from the use of chemical reagents, and avoiding complications such as soft tissue necrosis and osteoarthritis that may result from the use of liquid nitrogen freezing.  Ofluoglu et al. scraped the lesions of 25 limb bone giant cell tumors, high speed grinding and polishing of the residual cavity with high speed grinding and polishing, adequate cautery of the residual cavity with 120 watt argon helium knife combined with 90% phenol inactivation treatment, followed by bone cement filling of the residual cavity, with a mean follow-up of 34 months after surgery and recurrence in 1 patient (4%), Lewis et al. scraped the lesions of 37 limb bone giant cell tumors, high speed grinding and polishing with high speed grinding and polishing, and The residual cavity was treated with argon knife cautery until significant carbonization appeared around the residual cavity. The power of the argon knife was set at 100 watts and the cavity was filled with bone cement. The mean postoperative follow-up was 73.7 months, with a recurrence rate of 11%.  Benevenia et al. 2012 reported 93 cases of stage II and III benign tumors treated between 1992 and 2007 with lesion scraping and local inactivation, with a mean follow-up of 55 months and local recurrence in 15% of the 33 patients who underwent argon knife cautery treatment of the residual cavity. At the same time, statistically significant differences in tumor recurrence rates, functional outcomes, and postoperative complication results can be obtained with phenol inactivation.