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Oncology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Gill A. Levitt, Penelope Brock, Tanzina Chowdhury, Mark Gaze, Darren Hargrave, Judith Kingston, Antony Michalski, Olga Slater
limb salvage techniques called rotationplasty can be used. This involves resection of the tumour with the amputation of the knee region, with reunion of the rotated distal limb. For responding tumours, thoracotomy and resection of pulmonary metastases is undertaken.
High complication rate after extendible endoprosthetic replacement of the proximal tibia: a retrospective study of 42 consecutive children
Published in Acta Orthopaedica, 2018
Panagiotis Tsagozis, Michael Parry, Robert Grimer
Limb salvage is the preferred mode of treatment for malignant tumors of the extremities, since it results in superior functional outcome, offering at the same time equivalent local control and overall survival compared with amputation (Simon et al. 1986, Rougraff et al. 1994). However, management of the growing individual poses challenges: the skeletal growth must be taken into consideration when planning reconstruction. The use of extendible prostheses has gained popularity as it allows immediate mobilization and improved cosmesis for the patient (Henderson et al. 2012, Picardo et al. 2012, Schinhan et al. 2015). For tumors arising in the proximal tibia, however, concerns are that poor soft tissue coverage may increase the risk of infection and stiffness, as well as difficulty in reconstruction of the extensor mechanism resulting in restriction in the range of movement (Albergo et al. 2017). Previous study in a limited number of children, who were not included in this report, highlighted the high risk for complications after extendible endoprosthetic reconstruction for proximal tibia tumors (Grimer et al. 2000). However, this option is chosen for many children as it allows for retaining a cosmetically near-normal limb, which is not the case for amputation or rotationplasty. On the other hand, rotationplasty (but not an above-knee amputation) allows for an active lifestyle including sport activities, which are not compatible with endoprosthetic reconstruction due to the risk for mechanical failures. We present our experience from the largest series of patients in the medical literature, showing that limb salvage is feasible but at the expense of a high complication rate.
Current and future therapeutic approaches for osteosarcoma
Published in Expert Review of Anticancer Therapy, 2018
Douglas J. Harrison, David S. Geller, Jonathan D. Gill, Valerae O. Lewis, Richard Gorlick
Local control can be rendered either via limb-salvage surgery or ablative surgery. While limb-salvage surgery has become the most frequent local control preference for both patients and surgeons [44], amputations nevertheless remain an important surgical technique. Rotationplasty, often described as an intercalary amputation, remains a very rewarding and durable procedure. It is particularly applicable in instances where significant leg-length inequality is anticipated or in cases where the patient desires return to high-impact activities that jeopardize endoprosthetic reconstructions by way of early loosening, accelerated wear, or catastrophic mechanical failure.