Background: Limb amputation is a life-altering event with substantial physical, psychological, and social consequences. Despite advances in healthcare, amputation remains a major global health concern, particularly in regions with high burdens of diabetes and vascular disease. This study aims to analyze demographic characteristics, etiologies, and trends in amputations over a ten-year period at a tertiary-care center. Methods: We retrospectively reviewed medical records of patients who underwent amputation at our tertiary-care hospital. Collected variables included patients’ demographics, etiology, level of amputation, type of admission, and surgical specialty involved. Descriptive statistics were used to summarize the data. Associations between categorical variables were analyzed using chi-square tests, with post hoc pairwise comparisons adjusted using the Bonferroni method where applicable. Continuous variables were compared using the Mann–Whitney U test. A p-value of <0.05 was considered statistically significant. All analyses were conducted using IBM SPSS version 26.0. Results: A total of 647 patients underwent amputation, with a mean age of 56 years and a male predominance (65%). Diabetic complications were the leading cause (67.7%), followed by trauma (11.7%) and vascular diseases (11.6%). Lower limb amputations were more prevalent, with toe amputations being the most frequent (39%). Emergency procedures accounted for 72% of cases, and vascular surgery was the most involved specialty, followed by orthopedic surgery. Conclusions: Our study highlights a substantial burden of amputations, predominantly involving the lower limb, as well as a significant association with diabetic complications. These findings emphasize the urgent need for integrated diabetic care, early interventions, and public health strategies to reduce the burden of amputations in Saudi Arabia.

Osteosarcoma is an aggressive primary bone tumor commonly managed with multimodal therapy; however, the optimal sequencing of chemotherapy and surgery remains debated. Neoadjuvant chemotherapy (NACT) is widely used to facilitate limb-salvage surgery (LSS) and assess histologic response, yet its comparative benefit over upfront surgical resection remains unclear. This systematic review and meta-analysis aimed to compare oncologic and surgical outcomes between NACT followed by surgery versus upfront surgical resection in patients with osteosarcoma. A systematic search of PubMed, CENTRAL, and Google Scholar was conducted up to June 2025. Eligible studies included patients with histologically confirmed osteosarcoma treated with NACT plus surgery or upfront surgical resection. The primary outcome was overall survival (OS); secondary outcomes included disease-free survival (DFS), local recurrence (LR), distant metastasis, surgical complications, and chemotherapy-related adverse effects. Random-effects meta-analyses reported risk ratios (RRs) with 95% CIs and prediction intervals; leave-one-out influence and Hartung–Knapp (HK) adjustments were performed. Certainty was appraised with GRADE. Twenty-five studies involving 4,867 patients were included; 14 studies qualified for meta-analysis. Pooled analysis showed no significant difference in OS (RR: 1.09; 95% CI: 0.95–1.24; p = 0.225) or DFS (RR: 1.18; 95% CI: 0.73–1.89) between groups. However, NACT significantly reduced LR risk (RR: 0.45; 95% CI: 0.25–0.79; p < 0.05) and was associated with higher LSS rates. GRADE certainty was low for OS/DFS and moderate for LR. Although NACT did not improve survival versus upfront surgery, it was associated with reduced local recurrence and greater feasibility of limb-salvage, supporting its role within multimodal care, particularly when local control and limb preservation are priorities, and in complex or high-risk presentations.

Denosumab has transformed the management of giant cell tumor of bone (GCTB), particularly in cases that are unresectable or surgically morbid. However, accumulating reports of malignant transformation (MT) during or after therapy have raised concern about a potential causal association. We conducted a systematic review and meta-analysis to estimate the incidence of MT in denosumab-treated GCTB and to characterize the clinical, radiological, and pathological features of affected patients. We searched PubMed/MEDLINE, Scopus, and Web of Science to October 2025 for studies reporting denosumab-treated GCTB with MT. Clinical trials, cohort studies, case series, and case reports with original patient data were eligible. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment. A random-effects meta-analysis was used to pool MT incidence. Twenty-four studies were included in the qualitative analysis, and 11 (800 denosumab-treated patients) contributed to the meta-analysis. MT was reported in 18 patients. The pooled incidence of MT was 3% (95% CI 2–7%; I² = 49.2%). Patients who transformed typically had high-risk disease, characterized by axial or otherwise surgically challenging sites, multiple prior local procedures, recurrent disease, or previous radiotherapy. Among cases with available timing data, MT was diagnosed from 3 months to 6 years after denosumab initiation, although most transformations occurred during active treatment or within 1–3 years of treatment initiation. MT most often manifested as high-grade osteosarcoma or undifferentiated pleomorphic sarcoma, characterized by biphasic histology, a markedly increased Ki-67 index, and variable H3F3A status. The prognosis was poor despite aggressive multimodal treatment. Cohort studies were generally rated as fair to good quality, whereas non-randomized interventional studies had a serious to critical risk of bias. MT in denosumab-treated GCTB is rare and does not appear more frequent than historical baseline rates, but it predominantly affects a biologically and clinically high-risk subgroup. Vigilant clinical and radiological surveillance, prompt re-biopsy of atypical lesions, and referral to expert sarcoma centers are essential, and prospective registries with integrated molecular profiling are urgently needed.

Background and Objectives: Diabetic foot disease is a major cause of lower-limb amputation and is associated with substantial morbidity and mortality. While amputation is often considered definitive treatment, postoperative outcomes and their predictors remain incompletely characterized. Materials and Methods: This retrospective cohort study included all patients who underwent diabetic foot amputation at a tertiary care center between January 2015 and August 2025. Demographic data, comorbidities, laboratory parameters, and amputation-related variables were collected. The primary outcome was postoperative complications. Secondary outcomes included readmission, re-amputation, ICU admission, length of stay, and mortality. Logistic regression was used to identify predictors of postoperative complications. Results: A total of 437 patients were included (mean age 62.0 ± 11.8 years; 65.7% male). Postoperative complications occurred in 52.1% of patients, most commonly infections (31.6%) and acute kidney injury (18.1%). Readmission occurred in 50.6%, re-amputation in 23.4%, ICU admission in 28.7%, and mortality in 17.8%. On multivariable analysis, preoperative serum albumin was the only independent predictor of postoperative complications (aOR 0.944, 95% CI: 0.913–0.976; p < 0.001). Conclusions: Postoperative complications following diabetic foot amputation are common and associated with significant healthcare utilization and mortality. Preoperative hypoalbuminemia was the only independent predictor of postoperative complications, supporting its utility as an integrated biomarker of systemic illness (including inflammatory burden/infection and hepatic synthetic function) for perioperative risk stratification.

Background: Caudal septal deviation is a challenging condition that affects nasal function and aesthetics. Objectives: The aim of the study was to evaluate surgical practices for caudal septoplasty among otolaryngologists in Saudi Arabia and compare them with international approaches. Methods: A cross-sectional electronic survey was distributed to otolaryngologists across academic, governmental, and private healthcare institutions in Saudi Arabia. A parallel systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines using PubMed, Web of Science, and Scopus. Eligible studies published between 1954 and 2024 described techniques addressing caudal septal deviation with reported outcomes. The study protocol was prospectively registered before the study's start in PROSPERO (CRD42024621207). Results: Sixty otolaryngologists completed the survey. The most commonly used techniques were swinging door (76.6%), cartilage reshaping (51.7%), and suturing (48.3%). Only 16.7% had facial plastic surgery training. In the systematic review, 559 records were identified with 53 studies meeting the inclusion criteria involving 3564 patients, splinting or grafting (47.2%), and cartilage reshaping (30.2%) predominated. Patient-reported outcome measures (PROMs) were used in 66% of studies, primarily the Nasal Obstruction Symptom Evaluation scale, with scores improving from 70.2 to 16.1 postoperatively. Conclusions: Otolaryngologists in Saudi Arabia predominantly employ conservative caudal septoplasty techniques, with limited adoption of extracorporeal approaches and PROMs. These findings contrast with broader international practices and highlight the need for enhanced subspecialty training and standardized outcome evaluations. Level of Evidence: 5 (Therapeutic):

Background/Objective: The parotid gland is the largest salivary gland, and tumors arising from it exhibit wide histopathological diversity. Management approaches vary according to tumor characteristics and carry a risk of postoperative complications, particularly facial nerve injury. However, local data remain limited. This study aimed to describe the clinicopathological characteristics, surgical approaches, and postoperative outcomes of patients undergoing parotidectomy. Method: A retrospective cohort study was conducted at a high-volume tertiary center in Saudi Arabia. All consecutive patients who underwent parotidectomy between June 2015 and January 2025 were included. Demographic data, histopathological diagnoses, surgical procedures and postoperative complications were extracted from electronic medical records. Statistical analyses were performed using SPSS version 26, with A p-value of <0.05 considered statistically significant. Results: A total of 154 patients were included, with a mean age of 45.2 ± 12.6 years; 61% were male. Benign lesions constituted 87% of cases, with pleomorphic adenoma being the most common histopathological diagnosis. Malignancies accounted for 13% of cases, most frequently mucoepidermoid carcinoma. The most common postoperative complications were facial nerve palsy, followed by sensory numbness. Conclusions: The majority of parotid gland tumors in this cohort were benign, with pleomorphic adenoma as the most common histological subtype. Facial nerve palsy and sensory disturbances were the most common postoperative complications. These findings provide valuable local data on parotid gland lesions in Saudi Arabia and support current surgical management practices.