Musculo Skeletal Oncology

Apart from being involved in all tumor related surgeries’

• Spinal Hemiangioma
• Osteoid Osteoma
• Enchondroma
• Osteochondroma
• Giant cell tumors
• Osteosarcoma
• Chondrosarcoma
• Multiple Myeloma
• Secondaries in spine and elsewhere.

Orthopedics at Artemis orthopedic institute are experts in Limb salvage / joint replacement/ reconstruction for tumors involving upper and lower extremities etc.

Limb salvage surgery services

Artemis Orthopaedic Institute specializes in Limb salvage surgery for tumors involving upper and lower extermeties and also pelvis and scapula. In the Institute extensive work in salvage of limbs with difficult bone cancers is done where the affected part of the bone with tumor is removed without cutting off the whole limb and limb is saved from amputation


Purpose                       
Limb salvage surgery is performed to remove cancer and avoid amputation, while preserving the patient's appearance and the greatest possible degree of function in the affected limb. The procedure is most commonly performed for bone tumors and bone sarcomas, but is also performed for soft tissue sarcomas affecting the extremities. This complex alternative to amputation is used to cure cancers that are slow to spread from the limb where they originate to other parts of the body, or that have not yet invaded soft tissue.

Twenty years ago, the standard of care for a patient with a cancer in a limb was to amputate the affected extremity. Limb salvage surgery was an exception to the rule. Today, it is the exception that a patient loses a limb as part of cancer treatment. This is due to improvements in surgical technique, both resection and reconstruction, imaging methods (computed tomography [CT scan] and magnetic resonance imaging [MRI]), and survival rates of patients treated with chemotherapy.


Description
Also called limb-sparing surgery, limb salvage involves removing the cancer and about an inch of healthy tissue surrounding it. In addition, if had been removed, the removed bone is replaced. The replacement can be made with synthetic metal rods or plates (prostheses), pieces of bone (grafts) taken from the patient's own body (autologous transplant), or pieces of bone removed from a donor body (cadaver) and frozen until needed for transplant (allograft). In time, transplanted bone grows into the patient's remaining bone. Chemotherapy, radiation, or a combination of both treatments may be used to shrink the tumor before surgery is performed.


Limb salvage is performed in three stages. Surgeons remove the cancer and a margin of healthy tissue, implant a prosthesis or bone graft (when necessary), and close the wound by transferring soft tissue and muscle from other parts of the patient's body to the surgical site. This treatment cures some cancers as successfully as amputation.

Diagnosis/Preparation
Before deciding that limb salvage is appropriate for a particular patient, the treating doctor considers what type of cancer the patient has, the size and location of the tumor, how the illness has progressed, and the patient's age and general health.
After determining that limb salvage is appropriate for a particular patient, the doctor makes sure that the patient understands what the outcome of surgery is likely to be, that the implant may fail, and that additional surgery—even amputation—may be necessary.

Physical and occupational therapists help prepare the patient for surgery by introducing the muscle-strengthening, ambulation (walking), and range of motion (ROM) exercises the patient will begin performing right after the operation.

Aftercare
During the 5 to 10 days the patient remains in the hospital following surgery, nurses monitor sensation and blood flow in the affected extremity and watch for signs that the patient may be developing pneumonia, pulmonary embolism, or deep-vein thrombosis.

The doctor prescribes broad-spectrum antibiotics for at least the first 48 hours after the operation and often prescribes medication (prophylactic anticoagulants) and antiembolism stockings to prevent blood clots. A drainage tube placed in the wound for the first 24–48 hours prevents blood (hematoma) and fluid (seroma) from accumulating at the surgical site. As postoperative pain becomes less intense, mild narcotics or anti-inflammatory medications replace the epidural catheter or patient-controlled analgesic pump used to relieve pain immediately after the operation.


Exercise Intervention
Limb salvage requires extensive surgical incisions, and patients who have these operations need extensive rehabilitation. The amount of bone removed and the type of reconstruction performed dictate how soon and how much the patient can exercise, but most patients begin muscle-strengthening, continuous passive motion (CPM), and ROM exercises the day after the operation and continue them for the next 12 months..


Normal Results
A patient who has had limb salvage surgery will remain disease-free as long as a patient whose affected extremity has been amputated.

Salvaged limbs always function better than artificial ones. However, it takes a year for patients to learn to walk again following lower-extremity limb salvage, and patients who have undergone upper-extremity salvage must master new ways of using the affected arm or hand.

Successful surgery reduces the frequency and severity of patient falls and fractures that often result from disease-related changes in bone. Although successful surgery results in limbs that look and function very much like normal, healthy limbs, it is not unusual for patients to feel that their appearance has changed. Some patients may also need additional surgery within five years of the first operation.