Usually, antibiotic treatment is administered intravenously for 2 weeks and then prolonged orally for 16weeks [61, 62]. Other than the nor­mal preoperative antibiotic prophylaxis, careful antisepsis in the OR, and reduction of operative times, other attempted preventive treatments for SSI are the use of antibiotic-impregnated bone allografts [55, 62] and the use of antibiotic­loaded bone cement [63].

If debridement and antibiotic administration fails, the SSI treatment is allograft removal, tem­porary antibiotic-loaded cement spacer, and tar­geted antibiotic therapy for 3months (a 2-stages treatment), followed by reconstruction with another allograft or prosthesis [59].

After the second reconstruction, the SSI rate rises to 34%. Similarly, Mankin [64] describes a higher risk of SSI after a second (revision) allograft surgery, rising from 7.9% to 12.8%. The failure of the 2-stage treatment can lead in severe cases to amputation [53].

Cavity lling after curettage with antibiotic­loaded polymethylmethacrylate (PMMA) bone cement has a reduced risk of infection [65], while the use of allografts to ll the cavity after benign bone tumor curettage has a higher rate of infec­tion, with an associated low, but possible, risk of disease transmission and immune rejection [67].

Treatment is usually debridement, possibly cavity-lling removal and substitution with antibiotic- loaded PMMA, targeted antibiotic therapy, and adequate soft tissue coverage [65].

Surgical Site Infection (SSI) rate after curettage surgery in orthopedic oncology can widely vary, based on what is considered SSI, it can range between 4.1% [65] and 10.7% [66], when consid­ered as SSI also wound infections and supercial infections.

operatively. A careful follow-up can determine early detection and prompt treatment, with better outcomes [10, 73].

implant/allograft removal in almost 46% of cases, with loss of function and worse outcomes. External hemipelvectomy as the endpoint of SSI treatment is a last-step option rarely needed [17].

single institution) a series shows no cases of deep infections [93]. Surgical treatment for Chordomas is known to have a high risk of infective compli­cations [94].

therapy is associated with a higher rate of wound complications and a higher risk of infection in other studies [95, 96].

tors, both concerning the type of operation and the surgical approach. Conventionally the ele­ments accountable for SSI are divided into two main categories, the unchangeable (patient­related) and changeable (procedure-related) [8–11]. Patient’s related risk factors are age (>65 years old), American Society of Anesthesiologist (ASA) score, diabetes mellitus, cardiovascular disease, obesity, smoking, steroid use, nutritional status, and immunologic compe­tence. Smoking and substance abuse negatively impact wound healing and immune function, and malnourished patients are 15 times more likely to present SSI [12–16]. Procedure-related risk fac­tors are linked to the duration of surgery, blood loss, presence of instrumentation, and prolonged preoperative hospital stay. Anterior approaches have shown the least amount of postoperative infection, meanwhile, the posterior lumbar approach is the one with the greatest risk of infec­tions. This is due to the proximity of the surgical site with the anus and the genitourinary tract, with a high risk of involuntary contamination after the surgery [1, 17–19]. Also, it appears that simpler operations without implants present a lower incidence of SSI when compared with major operations with instrumented fusion. Those ndings are linked to the fact that major surgery also means more blood loss, longer surgi­cal time, and longer hospitalization of the patient. The presence of instrumentation can provide bac­teria (such as Staphylococcus species) with a

Diagnosis usually made both by clinical and radiological ndings considering that supercial and deep SSI can have different characteristics. While supercial SSI can be clinically evident from the early stage, deep SSI can hide for a long