Limb Salvage for Musculoskeletal Tumors in the Austere Environment: Review of the Literature With Illustrative Cases Regarding Considerations and Pitfalls.
| Autor: | Morris SC; From the Department of Orthopaedic Surgery, Loma Linda University, Loma Linda, CA (Dr. Morris, Dr. Nelson); the Department of Surgery, Hopital Adventiste d'Haiti, Port-au-Prince, Haiti (Dr. Nelson); and the Division of Orthopaedic Surgery, Department of Surgery, City of Hope National Medical Center, Duarte CA (Dr. Zuckerman)., Nelson SC, Zuckerman LM |
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| Jazyk: | angličtina |
| Zdroj: | Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews [J Am Acad Orthop Surg Glob Res Rev] 2020 Oct 01; Vol. 4 (10), pp. e19.00172. Date of Electronic Publication: 2020 Oct 01. |
| DOI: | 10.5435/JAAOSGlobal-D-19-00172 |
| Abstrakt: | Although there is literature discussing the treatment of acute and chronic trauma in austere environments, no literature or guidelines for the treatment of musculoskeletal tumors exist. This series discusses case examples with considerations and pitfalls of performing limb-salvage surgery in an underserved location. Cases of limb-salvage surgery performed by the same orthopaedic oncologist in Haiti and the Dominican Republic are discussed with a review of the literature on limb salvage for musculoskeletal tumors in developing nations. All patients successfully underwent limb-salvage surgery after considering multiple factors including tumor type and location. Patients with metastatic disease, likelihood of substantial blood loss, and poor health were not candidates for limb-salvage surgery. Medical missions and the development of partnerships with established training programs make limb salvage a greater possibility. Knowledge of the facility, anesthesia support, and instrumentation available is vital. Advanced imaging, blood products, and allograft are likely unavailable or difficult to obtain. Established continuity of care is necessary, and training of the local surgeon should be provided. Surgery should only be considered if it is safe and provides more of a benefit to the patient than an amputation. (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Orthopaedic Surgeons.) |
| Databáze: | MEDLINE |
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