Oncologic Approaches to Pediatric Limb Preservation

Weisstein, Jason S.; Goldsby, Robert E.; O’Donnell, Richard J.

doi:10.5435/00124635-200512000-00007

Cited by 28 publications

(24 citation statements)

References 38 publications

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“…In addition, most patients with sarcoma are either adolescents or at a pediatric age and the tumor is located in an extremity, most frequently the lower extremity [4,17,28]. This is a demanding situation for surgeons treating those patients to reconstruct the limb with the most durable procedure with the least length discrepancy.…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Allograft Reconstruction After Sarcoma Resection in Children Younger Than 10 Years Old

Múscolo

Ayerza

Aponte-Tinao

et al. 2008

Clin Orthop Relat Res

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Section: Introductionmentioning

confidence: 97%

“…Bone sarcomas are presently treated mainly with preservation of the affected limb [10,17,28]. In addition, most patients with sarcoma are either adolescents or at a pediatric age and the tumor is located in an extremity, most frequently the lower extremity [4,17,28].…”

Section: Introductionmentioning

confidence: 99%

Allograft Reconstruction After Sarcoma Resection in Children Younger Than 10 Years Old

Múscolo

Ayerza

Aponte-Tinao

et al. 2008

Clin Orthop Relat Res

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“…It was hard to treat because of relapse of osteomyelitis, but repeated curettage with local and systemic antibiotics and also adjuvant hyperbaric oxygen has finally given a good result. Our results show that there are more difficulties in the limb saving treatment of patients under eight years of age [12,13,16]. It was hard to achieve the loading in the device with the youngest child; he had the most limited motion and the greatest shortening.…”

Section: Discussionmentioning

confidence: 76%

Epiphysis preserving resection of malignant proximal tibial tumours

Kiss

Treuer

Szabó

et al. 2012

International Orthopaedics (SICOT)

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Purpose The purpose of the study was to evaluate the treatment of five patients with proximal tibial epiphysis preserving resection for malignant tumours of the tibia. Method Three patients suffered from Ewing sarcoma, two had osteosarcoma. The proximal level of the resection was in the line of the growth plate in four patients, and 2 cm below of the growth plate in one patient. The distal resection level was in the diaphysis, depending on the tumour border. The resected part of the tibia was substituted by both the ipsilateral and contralateral fibulas. The two fibulas were proximally built into the epiphysis, the contralateral, freely transplanted fibula was placed distally into the tibial diaphysis. The leg was fixed in an Ilizarov frame. Results The follow-up period was 4.9 years on average (range, 3.5-8 years). Neither local recurrence nor metastasis was noticed in patients with tibia tumour resection during the observation time. Proper fixation of the transplanted fibula with all of the patients, both proximal to the tibia epiphysis and distal to diaphysis, was experienced. The range of motion of the knee was 122°on the average. Two patients can walk without support and three can walk with an orthosis fully weight bearing. The limb shortening of the affected side was 2.6 cm on average (range,1.5-4.5 cm). In three patients the transplanted opposite side fibula has broken. In one patient, chronic osteomyelitis developed at the distal part of the transplanted fibula. Conclusions The difficulties of intercalary segment supplementation were present to a greater extent because of the small size of proximal epiphysis, but the preserved knee joint can produce better function for the patient in this limb-saving surgery.

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“…Many surgeons maintain that limb conservation in patients younger than 8 years is a relative contraindication. 68 The survival of the construct, adjustments to accommodate skeletal growth, ability of the child to understand the need for activity restrictions, cooperation with physical therapy that may compromise the outcome must be considered in the decision-making process. Lower extremity reconstruction is associated with many more complications than the upper extremity.…”

Section: Limb-sparing Tumor Resectionmentioning

confidence: 99%

Surgical Management of Primary Osteosarcoma

Yasko

2009

Cancer Treatment and Research

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Surgical strategies for the primary tumor for patients with extremity and pelvis osteosarcoma have evolved from the ablative to limb-sparing approaches over the past three decades. Favorable oncologic and functional outcomes with contemporary tissue-conserving techniques consistently observed in skeletally mature patients have prompted the application of similar approaches to a growing number of eligible skeletally immature patients. In response to emerging long-term outcome data, current strategies have focused principally on refining the nature and scope of surgical resection to preserve uninvolved tissues, and on the adoption of novel biological and nonbiological skeletal and soft-tissue reconstruction methods to optimize function. We focus on these clinical issues and discuss current efforts to advance the surgical management of the primary tumor and address the limitations of the definitive treatment of the primary tumor, including locally recurrent disease and complications of skeletal reconstructions.

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Oncologic Approaches to Pediatric Limb Preservation

Cited by 28 publications

References 38 publications

Allograft Reconstruction After Sarcoma Resection in Children Younger Than 10 Years Old

Allograft Reconstruction After Sarcoma Resection in Children Younger Than 10 Years Old

Epiphysis preserving resection of malignant proximal tibial tumours

Surgical Management of Primary Osteosarcoma

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