Limb Sparing Surgery: Moving Forward

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Abstract

BACKGROUND

Endoprosthetic reconstruction for bone tumor surgery was introduced in the 1970s. It has since evolved to be a successful and acceptable method of reconstruction and has become the gold standard of treatment. At present, 85% of patients will undergo limb salvage surgery with survival ranging from 60% to 90%.

PURPOSE

The complexity of bone sarcomas and limb-sparing surgery is discussed beginning with the initial presentation of the sarcoma patient. Limb-sparing surgery is depicted from initial exposure and removal of the diseased bone, placement of endoprosthetic, and presentation of patient postoperatively. A graphical portrayal is given to outline a stepwise and multidisciplinary approach when treating bone tumor patients. The discussion also includes postoperative care following surgery. Key aspects of nursing care are outlined. Management of patients with bone tumors involves a multidisciplinary team experienced in diagnostics, chemotherapy, and surgery. The priorities for patient and family education are highlighted.

EVALUATION/OUTCOMES

There are an increasing number of surgical options available for orthopedic oncology. Research has shown little difference between amputation and those who undergo limb-sparing surgery in overall quality of life. Several studies have demonstrated no adverse effect on local recurrence and overall survival in patients undergoing limb salvage surgery compared with those undergoing amputation. Realistic expectations and thorough multidisciplinary patient/family education contribute to optimistic end results.

IMPLICATIONS FOR PRACTICE

Nursing considerations in the management of patients undergoing limb-sparing surgery begin prior to and reach beyond the immediate postoperative period. Patient/family education includes expectations and limitations, emotional support, pain management, and progression of activity. A multidisciplinary approach with nursing, oncology, orthopedic surgery, pain management, physical therapy, and occupational therapy contribute to a successful management plan. The importance of compliance and continued support after discharge is integral to achieving a positive outcome.

DISCUSSION

Moradi et al. found no difference in the disease-free and overall survival outcomes when amputation was compared with limb salvage in 447 patients treated for a pathological fracture of a malignant bone tumor. In a study done by Henderson et al., data correlate with previous scores and indicate a high degree of emotional acceptance after limb salvage with an expandable endoprosthesis in a pediatric population.

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