LIMB SALVAGE IN A DEVELOPING ECONOMY: FUTILE OR AUSPICIOUS

Seyi IdowuFWACS FMCS Ortho

Limb salvage, limb sparing or limb saving techniques Procedures performed as alternatives to

amputations. Arthrodesis Arthroplasty Alloprosthetic composite Endoprosthetic reconstruction Rotationplasty

Limb salvage defined!

Indications

Tumours : Bone and soft tissue sarcoma, aggressive benign tumours

Trauma: Mangled extremity, crush injuries Infections: Osteomyelitis, septic arthritis

(Native and non native joints)

Stages of limb salvage

Resection or debridement Reconstruction with implant,EPR,SPACER,

External device, Autograft/ Allograft Soft tissue reconstruction

Before limb salvage!

Consider type of lesion Consider stage and location BO-NE-VE-ST principle Cierny and Mader criteria Educate patient Physio and OT Gather human resources- MDT eg LAMON Aftercare

tumour

Grimer etal 1997 Cost of amputation $9442 + $16033 yrs Cost of EPR $21002 +1419yrs

trauma

Infection

Futile?

Audacious: recklessly bold

Auspicious : Conducive to success

Effective and cheaper chemotherapy : NGO Precision imaging technique : MRI, CT, angiograms Human resources Multidisciplinary care: Lagos musculoskeletal oncology

network (LAMON)