Hyperthermic isolated limb perfusion. The switch from Steinmann pins to Omni-tract assisted isolation Dimitrios Stamatiou, MD, PhD, a,1 Christos V. Ioannou, MD, PhD, b, * ,1 Nikolaos Kontopodis, MD, PhD, b Dimosthenis Michelakis, MD, a Konstantinos Perisinakis, MD, PhD, c Konstantinos Lasithiotakis, MD, PhD, d and Odysseas Zoras, MD, PhD a a Department of Surgical Oncology, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece b Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete Medical School, Crete, Greece c Department of Medical Physics, University Hospital of Heraklion, University of Crete Medical School, Heraklion, Crete, Greece d York Teaching Hospital NHS Foundation Trust, Scarborough, UK article info Article history: Received 31 October 2016 Received in revised form 21 January 2017 Accepted 17 February 2017 Available online 24 February 2017 Keywords: Melphalan Melanoma Sarcoma Chemotherapy Tumor necrosis factor (TNF) Omni-tract retractor abstract Background: Hyperthermic isolated limb perfusion (HILP) represents an alternative to amputation for patients with either in-transit melanoma or unresectable soft tissue sarcoma, entailing delivery of high-dose chemotherapy after isolation of the extremity, under hyperthermic conditions. Stabilization of the Esmarch elastic bandage is so far performed with the use of Steinmann pins. In this study, we presented our experience with HILP and demonstrated an alternative technique for limb isolation using an Omni-tract retractor instead of the traditional Steinmann pin, while comparing the two methods. Methods: Forty patients, 28 with recurrent in-transit melanoma and 12 with locally advanced/recurrent sarcoma of the limbs, underwent HILP in a single institution and were included in the study. The Steinmann pin was applied in the first 23 cases, whereas the Omni-tract retractor was applied in the latter 17 patients. Results: The median follow-up for the whole study group was 17.5 mo, whereas the overall response rate was 92.9% for melanoma and 75% for sarcoma patients. Both overall survival and local progression-free survival differed significantly between patients with complete response and those with partial response, stable disease or progressive disease. The use of the Omni-tract retractor was advantageous in every examined field, with the overall complication rate, duration of analgesic administration, and total opioid and paracetamol dose, being significantly less in the Omni-tract patient group. * Corresponding author. Assistant Professor of Vascular Surgery, Chief of the Vascular Surgery Unit, University of Crete e Medical School, P.O. Box 1393, 71110 Heraklion, Greece. Tel.: þ 30 2813 40 2379; fax: þ 30 2810 375 365. E-mail addresses: ioannou@med.uoc.gr, xiaonnou@uoc.gr (C.V. Ioannou). 1 Equal contribution authors. Available online at www.sciencedirect.com ScienceDirect journal homepage: www.JournalofSurgicalResearch.com journal of surgical research  1 june 2017 (213) 147 e157 0022-4804/$ e see front matter ª 2017 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jss.2017.02.023