Jyothish Kavungal1, Subramanian Vaidyanathan2, Sameer Khateeb Mohammed3, Ashwin Baby4, Afsal Rasheed5
BACKGROUND
Limb salvage surgeries - Are they useful compared to amputation in bone tumours
(malignant/recurrent). Starting from 1980s, bone tumour treatment has seen a
revolution with the advent of limb salvage surgeries. From an era where
amputation was the only option to the current day function preserving resections
and complex reconstructions has been a major advance. The surgeon must ensure
adequate resection of the involved bone and soft tissue so as to minimize chance
of local recurrence. At no stage must adequate disease clearance be compromised
in an attempt to achieve limb salvage. We analyzed its relevance among our rural
population at a tertiary level care centre. Limb salvage surgery basically involves
resection and reconstruction. Reconstruction can be either biological or endo
prosthetic. Biological can be autograft or allograft. Endoprosthesis can be fixed
(custom-made) or modular. Expendable bones like fibula or ulna may not require
reconstruction after resection. Prosthesis provide an immediate return to function
and unlike bone they are not affected by ongoing adjuvant chemotherapy and
radiotherapy.
METHODS
We conducted an 18-month prospective follow-up study on 10 patients (6 males
and 4 females) who had undergone limb salvage surgeries during 2017 - 20 at
Government Medical College, Thrissur. Wide excision, wide excision & biological
autograft reconstruction, wide excision & modular endoprosthesis reconstruction
are the different surgical modalities used. Patients were followed up clinically and
radiologically in the orthopaedic out-patient department (OPD) at 6 weeks, 12
weeks and up to 1 ½ years at every 3 months. Functional scoring has been done
using musculoskeletal tumour society (MSTS) - 87 scoring system.
Study duration: 2017 October to 2020 October (3 years).
RESULTS
The average score is 64.6 % using the MSTS - 87 system. Maximum score was 83
% and the minimum was 62 %. Most of our patients are doing well and pursuing
near-normal life with limb salvage surgeries with very minimal complications. One
of our patients succumbed to the disease during the follow-up period.
CONCLUSIONS
Limb salvage is a better alternative to amputation in malignant and recurrent bone
tumours in carefully selected and thoroughly evaluated patients.
