A 14-year-old girl with Ewing's sarcoma of the proximal fibula is being planned for limb salvage surgery. The criterion of a 'wide' surgical margin as defined by Enneking is:
- A Tumor removal through its reactive zone with a thin margin of normal tissue
- B Removal of the entire compartment containing the tumor
- C Excision of the tumor with a cuff of normal tissue in all planes, outside the reactive zone ✓
- D Piecemeal removal of macroscopic tumor leaving microscopic disease
Correct answer: C. Excision of the tumor with a cuff of normal tissue in all planes, outside the reactive zone
Explanation
Enneking's margin definitions: intralesional = through tumor (positive margins); marginal = through reactive zone; wide = beyond reactive zone with a cuff of normal tissue; radical = entire compartment removed. Wide margins are the standard required for limb salvage of high-grade sarcomas and are associated with local recurrence rates comparable to amputation when combined with neoadjuvant chemotherapy. A marginal excision risks leaving satellite tumor nodules in the reactive zone.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.