CRITICAL LIMB SALVAGE SURGERY AT FORTIS, MOHALI HELPS IN SAVING 16-YEAR OLD’S LEG
Amritsar, September 28 :
16-year-old girl, Priyankjeet Kaur from Amritsar belt, had been diagnosed with Ewing’s Sarcoma of the proximal tibia, which is a type of cancer of the leg bone.
She was advised amputation at a couple of centres elsewhere. She received four cycles of chemotherapy and was planned for surgery. Her MRI showed involvement of approximately 22 cm of the shin bone. Conventional limb salvage surgery using mega prosthesis would have resulted in a loss of approximately 24 cm of her native bone.
However, in an attempt to preserve her natural bone, she was planned for surgery with a novel technique called “Pedicled Cryotherapy” which was recommended by Dr. Rajat Gupta, Orthopaedic Oncologist. Limb salvage surgery is a norm nowadays in the management of bone sarcomas.
Dr. Gupta informed, “In this, the cancerous bone was isolated without removing it from the body and dipped in liquid nitrogen which has a temperature of -196 C, which kills all the cancer cells. The sterilized bone so formed was put back and only the articular surface was replaced with a hinge knee prosthesis. Post-operatively, the patient was able to walk full weight bearing initially with a walker and then gradually without it and was given adjuvant chemotherapy.”
“We could save more than 90 % of her native bone by this technique, which provides a better functional outcome, increases the life of the implant, reduces the need for revision surgery, and provides the bone stock for revision surgery if required”, he added.
Earlier, bone cancer was synonymous with the cutting of the limb (amputation), but now we can remove only the cancerous bone without cutting the limb thereby preserving the function. The commonest procedure done in primary bone cancer is replacing the cancerous bone with an artificial implant called a mega prosthesis. Though this mega prosthetic replacement provides immediate weight-bearing and functional use of the limb it doesn’t last forever and requires revision surgeries later on in life to change this artificial implant.
Orthopedic oncology and management of bone cancers have taken a giant leap over the last decade and we are gradually shifting towards preserving as much native bone as possible without compromising the oncological margins.
Dr. Rajat Gupta concluded, “With a multidisciplinary team approach, bone cancer is not only curable but with the current surgical techniques, we can also save the limb in the majority and even the natural joint in many provided the patient reaches the specialist on time.”