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Welcome Lecture: Dr. Rizki Rahmadian
Welcome Lecture: Dr. Rizki Rahmadian
Amputation
Introduction
Concept of limb salvage surgery 25 years
1970s adriamicyn & MTX
Ralp Marcove, Kenneth Francis & Hugh Watts
limb salvage surgery technique
Introduction
Introduction
This dramatic alteration :
1. Improved understanding of tumor biology;
2. Effective induction chemotherapy;
3. Technical advances in surgical techniques;
4. Better characterization of the biomechanics of the human
skeleton;
5. Advanced material engineering and manufacturing
techniques;
6. The development of a reliable, stable modular prosthesis
for reconstruction of the hip, shoulder, and knee.
Work-up
Multidisciplinary team :
Orthopedic oncologist
Medical oncologist
Radiation oncologists
Musculoskeletal radiologist
Pathologist
Clinical psychologist
Social worker
Staging
The basic staging work :
High quality plain radiographs
Magnetic resonance imaging
study of the entire tumor and
nearby anatomic structures
Computed tomography scan of the
chest
Whole body technetium bone scan
Biopsy of the tumor
Work-up
The biopsy site must be carefully
planned and located along so-called
limbsalvage lines
Biopsy
Drain Placement
Staging
Patient Education
The patient and the patients family
should be given the opportunity to
participate in the decision
Indication
Every patient with a malignant tumor of the
extremity should be considered for limb salvage.
The patients prognosis has a limited impact on
the decision to perform limb salvage surgery.
In selected cases, limb salvage can be
combined with metastasectomy.
Indication
Minimum morbidity and rapid return to
function.
Patients can enjoy relief from pain,
improved quality of life, and intact body
image that limb salvage can offer, even if
they may not survive long-term.
Barriers
Barriers to limb salvage include
Poorly placed biopsy incisions,
Major vascular involvement,
Incasement of a major motor nerve,
Pathological fracture of the involved bone,
and others.
These adverse factors should not be viewed
as absolute contraindications.
Resection Arthrodesis
Resection Arthrodesis
Osteoarticular Allograft
Endoprosthesis
Endoprosthesis
Expandeble endoprosthesis
Case
Thank you