Musculo-skeletal tumor surgery

Dr. Md. Sajjad Husain

Treatment of malignant bone tumors most often consists of chemotherapy and / or radiation, as well as surgery. Surgical techniques are rapidly improving, especially with the advancement of limb salvage surgery. As recently as 10 to 20 years ago, the surgical answer to aggressive tumors of the extremity was amputation. While this is necessary in certain cases today, many patients are treated with limb salvage, or limb sparing surgery, with similar results. These operations are designed to save the limb while removing the tumor. Special prostheses, bone grafts and bone transplantation, are all techniques used in these surgeries.
In our country, we can not practice the limb salvage surgery routinely because patient can not afford this costly surgery. We do limb salvage surgery in case of Osteosarcoma, Ewings sarcoma by using custom made prosthesis & allograft in last two years.At NITOR we have one musculo-skeletal tumor unit, which is run by orthopaedic surgeons & headed by me as professor in charge. With the revolutionary change in orthopaedic surgery in NITOR, sub-specialty such a subject will opens a new horizon for the musculo-skeletal tumor treatment in near future. We shall able to do limb salvage surgery with endoprosthesis, that will improve our present situation. We believe, such improvement will diverse our patients from foreign movement . We could not introduce vascularized auto-graft but with collaboration of our plastic and reconstructive surgery unit soon we shall be able to do vascularized grafting also.
A Limb-salvage (otherwise known as limb-sparing) surgery involves removing a malignant (cancerous) bone or soft tissue tumor without amputation and replacing the bone and / or joint with an allograft (bone graft), endoprosthesis (artificial devices) or composite (combining allograft and endoprosthesis), soft tissue and muscle transfers to cover and close the site and restore motor power also are part of the procedure. It takes an average time of 1 year for patients to learn how to walk after limb-salvage involving a leg. Rehabilitating the patient is more intense after amputation. If the patient does not take part in the rehabilitation program, the salvaged arm or leg may become useless. At NITOR previously we did incisional biopsy or FNAC for diagnosis of bone tumors, but now we are doing core needle biopsy for many of the cases. In Giant cell tumor lesion we are doing Sandwich technique. After curettage and phenolization ,we put morcellized bone graft under the subchondral bone, then we put spongiostan and then the remaining large cavity is filled with bone cement.