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WELCOME LECTURE

WELCOME LECTURE. dr. Rizki Rahmadian. “ mimpi adalah kunci untuk kita menaklukan dunia, berlarilah tanpa lelah sampai engkau meraihnya ”. nidji. Limb Salvage Surgery for Extremity Bone Sarcoma. Amputation. Introduction. Concept of limb salvage surgery  25 years 1970s  adriamicyn & MTX

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WELCOME LECTURE

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  1. WELCOME LECTURE dr. Rizki Rahmadian

  2. “ mimpi adalah kunci untuk kita menaklukan dunia, berlarilah tanpa lelah sampai engkau meraihnya” nidji

  3. Limb Salvage Surgery for Extremity Bone Sarcoma

  4. Amputation

  5. Introduction • Concept of limb salvage surgery  25 years • 1970s  adriamicyn & MTX • Ralp Marcove, Kenneth Francis & Hugh Watts  limb salvage surgery technique

  6. Introduction Today 90-95 % patient with extremity sarcoma who are treated at major centers specializing in musculoskeletal oncology can undergo limb-sparing surgery procedures

  7. 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.

  8. Early Management & Referral • A successful limb salvage depends on : • A well - coordinated and timely series  the first physician to see the patient • History and general examination • The basic work-up should include high quality plain radiographs for bone lesions.

  9. Early Management & Referral Biopsy is not a part of the initial management of these lesions and is usually the last step in the work-up. The biopsy should be performed by the surgeon who will be doing the definitive surgery.

  10. Work-up • Multidisciplinary team : • Orthopedic oncologist • Medical oncologist • Radiation oncologists • Musculoskeletal radiologist • Pathologist • Clinical psychologist • Social worker CLINICO PATHOLOGICAL CONFRENCE

  11. 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

  12. Work-up The biopsy site must be carefully planned and located along so-called “limb—salvage lines”

  13. Biopsy

  14. Drain Placement

  15. Staging

  16. Patient Education The patient and the patient’s family should be given the opportunity to participate in the decision

  17. Indication • Every patient with a malignant tumor of the extremity should be considered for limb salvage. • The patient’s prognosis has a limited impact on the decision to perform limb salvage surgery. • In selected cases, limb salvage can be combined withmetastasectomy.

  18. 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.

  19. 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.

  20. STAGES OF LIMB-SPARING SURGERY Limb-sparing procedure can be divided into five stages : • Neoadjuvant chemtherapy • Tumor resection must spare significant structures. • Stable, painless skeletal reconstruction • The surrounding and supporting soft tissue • Adjuvant chemotherapy

  21. Huvos Tumor Necrosis Grading System

  22. Surgical Resections and Reconstructions • The cornerstone of a limb salvage procedure is a complete resection of the tumor with an adequate margin. • Margins can be defined as intralesional, marginal, wide, and radical

  23. Surgical Resections and Reconstructions • After completion of the tumor resection, the surgeon must reconstruct the resulting surgical defect. • The excised segment of bone must be replaced • Large internal prosthesis, • Segment of allograft bone, • Composite of an allograft and a prosthesis • Other methods.

  24. Resection Arthrodesis

  25. Resection Arthrodesis

  26. Osteoarticular Allograft

  27. Endoprosthesis

  28. Endoprosthesis

  29. Expandeble endoprosthesis

  30. Case

  31. Survival : 5 yaers survival rate 40 -70 %, • local recurrence : 5 -10 % • Immidiatete and Delayed Morbidity : increase  revision • Function : better than amputation • Psycosocial Benefits : gooad early psycosocial adjustment

  32. Thank you

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