This episode is sponsored by the American Academy of Orthopedic Surgeons. Have you heard about the Resident Orthopedic Core Knowledge Program? The American Academy of Orthopedic Surgeons has partnered with leading experts in the field to bring you ROC, the online learning platform developed for U.S. residency programs. Free to residents, ROC empowers you to build a foundation to prepare you for the OITE and ABOs part one exam. And remember, access to the ROC content is free for residents. Get started at rock.aaos Hello everybody, welcome back to yet another episode of the Nailed it Ortho podcast. You are tuned into our board slash our OITE review series. And this episode, we're going to continue to talk about some more oncology. We're going to go over some general principles. Uh, we're going to continue some general principles and we're going to go over some kind of basics of radiation and treatment and all things that you need to know. Again, if you haven't already go and check out our podcast companion book that goes along to all of these podcasts episodes You can take notes and those and they literally that goes right along with everything that we're saying and if you have not already shared this with one person one friend and We'll see everybody soon You are now listening to nailed it the orthopedic surgery podcast featuring doctors Jay Fitz and Wendell Cole What are some of the different types of resection margins?

Yeah. And this is where people tend to get a little tripped up in. I guess this is my field. So I'm like, well, I'm not sure why, but I get a lot of questions on resection margins. And honestly, the easiest way to think about it is radical resections don't really happen anymore. We don't really take out an entire muscular compartment just because we have radiation nowadays and so a vast majority of the time a wide resection is what is used for sarcoma. So radical resection is you resect an entire compartment. So basically, let's say there's a tumor in the vastus medialis. A radical resection is you're taking all of the quads. So vastus intermedius, rectus and vastus lateralis, which seems like kind of a big surgery for just a tumor that's contained within one muscle. But a wide resection is when you leave a cuff of normal tissue that doesn't have tumor cells in it. And the standard teaching is about one and a half to two centimeters of normal tissue. However, myself and my fellowship mentors, a healthy margin, whether it's two millimeters or two centimeters, is a healthy margin. And so we always got much closer than two centimeters, but for the test, two centimeters is the margin for a wide resection. Marginal resection is when you are basically only taking the tumor out. And a marginal resection happens in things like lipomas, atypical lipominous tumors, ganglion cysts, more benign lesions are done in a marginal manner, and then intra-lesional is when you cut into the lesion in order to remove it. Things like a giant cell tumor, aneurysmal bone cysts, unicameral bone cysts, symptomatic endchondroma, low- chondro sarcoma, those are all things where you open up the cortex and you're essentially using a curate and a bur and argon beam and all the other fancy tools to take the tumor out from the inside out essentially. So radical resections are major surgeries, wide resections are also major surgeries, but you only take out a cuff of tissue, not an entire compartment. Marginal is when you take the tumor out itself, but no cuff of healthy tissue, and then intralesion is when you go inside the lesion and remove it that way.