The Clinical Application of the Bi Digital O-Ring Test in the Operating Room: A Case Report

Abstract

AIM:

A pathological finding, tumor size and metastasis decide the resection area, but the resection margin depends on the past statistical data. We applied the Bi-Digital O-Ring Test in order to decide the resection margin of the tumor. And we compared the pathological findings of the resected tumor and the findings by the Bi-Digtal O-Ring Test.

Method:

68 year old male. Squamous cell carcinoma on right thigh.

Patient recognized that a 2cm tumor was palpable at right thigh at 1993. The tumor gradually to 15×8 cm. The ulceration appeared on the tumor at 1997. He consulted a nearby dermatologist to care for the ulceration from 1997 until 1998. The ulceration grew. Infection with MRSA appeared on the ulceration. The patient consulted Hiroshima University for amputation in April 1999.

We determined the invaded margin around the tumor using a biopsy specimen of tumor by the Bi- Digital O-Ring Test on May 1999. The maximum invaded margin was 6.5 cm from the proximal border of the tumor. The average border was about 2.0 cm. The border of resection was reported maximum 5 cm clinically.

We checked the right thigh of the patient on the operating table with indirect Bi-Digital O-Ring Test using a soft laser beam. The examiner was Hiroshi Muneshige. The indirect supporter was Dr. Tomohiro Asou. The standard ring was thumb-ring. The Bi-Digital ORing Test result was minus 5.

We disarticulated the right hip and performed resection of the right inguinal lymph node on May 1999. The resection margin was more than 6.5 cm. We checked the flap by indirect Bi-Digital O-Ring Test with the same examiner. The Bi-Digital O-Ring Test result became zero on the normal flap. But we checked the open wound, muscle stump and subcutaneous tissue using the Bi-Digital O-Ring Test. The result was minus 5. We checked the resected lymph node using indirect Bi-Digital O-Ring Test. The result was no metastasis using specimen of tumor and possibility of infection using antibiotics.

The pathologist reported that the tumor was a squamous cell tumor, and the margin was cancer free, and no metastasis at the lymph nodes.

CONCLUSION:

We used the clinical application Bi-Digital O-Ring Test during an operation to check the residual malignancy tissue. We need a long follow up of the patient to check the recurrence of the right stump for the evidence made medicine.