A suspected malignant bone tumour of the distal tibia requires biopsy before definitive surgery. Which principle of biopsy technique must be followed?

• A Transverse incision over the most superficial part of the swelling
• B Drain placement after biopsy to prevent haematoma
• C Incision placed away from the tumour to protect it from contamination
• D Longitudinal incision aligned with the future surgical incision, with the biopsy tract excised en bloc at definitive surgery ✓

Explanation

The biopsy should be planned by the surgeon who will perform the definitive resection. A longitudinal incision along the limb allows the entire biopsy tract, scar and drain track to be excised en bloc with the tumour as contaminated tissue, preserving the option of limb salvage. A transverse or poorly placed incision can convert a salvageable limb into one requiring amputation because the tract cannot be removed within the wide margin. Drains should exit in line with the incision.

Reference: Campbell's Operative Orthopaedics, 14th ed.

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