Comprehensive Extremity Reconstructions in Orthopedic Cancers
Comprehensive extremity reconstruction refers to the surgical procedure of rebuilding a damaged extremity, such as an arm, hand, leg, or foot. This type of surgery typically involves the use of advanced techniques and materials to restore both the form and function of the affected extremity.
The procedure of comprehensive extremity reconstruction can be performed for a variety of reasons, including:
Traumatic injuries: Extremity reconstruction surgery is often performed to repair injuries caused by trauma, such as fractures, dislocations, and soft tissue injuries.
Tumors: In some cases, tumors or cancerous growths may require the removal of an extremity, which can be reconstructed using surgical techniques.
Congenital abnormalities: Some people are born with deformities or abnormalities of the extremities, which can be corrected through reconstructive surgery.
Degenerative conditions: Certain degenerative conditions, such as osteoarthritis or rheumatoid arthritis, can cause significant damage to the joints and other structures of the extremities, which may require reconstruction surgery to alleviate pain and restore function.
Comprehensive extremity reconstruction surgery typically involves a team of specialists, including orthopedic surgeons, plastic surgeons, and physical therapists. The specific techniques and materials used in the procedure will depend on the individual case, but may include bone grafting, joint replacement, soft tissue reconstruction. Recovery from comprehensive extremity reconstruction surgery can be a lengthy process, requiring extensive rehabilitation and physical therapy to restore range of motion, strength, and function to the affected extremity. However, with proper care and treatment, many people are able to achieve excellent outcomes and a significant improvement in their quality of life.
Diagnosis Process in Orthopedic Cancers
Bone cancers are rarer than other cancers. Malignant tumors of the bone are detected in only one-tenth of the benign ones. Professor Levent ERALP, M.D. one of Acıbadem Hospital’s Orthopedists, says that for every 5000 breast cancers, one skeletal system cancer (sarcoma) is seen. Therefore, the experience of pathologists, radiologists and surgeons dealing with the diagnosis and treatment of bone and soft tissue tumors is 5000 times less than that of a pathologist, radiologist and surgeon dealing with breast cancer. In fact, accurate results are obtained when patients with orthopedic cancers are only referred to experienced and educated people. In order to treat these cancers, a correct diagnosis must be made. For the correct diagnosis, it starts with the correct examination and questioning the patient correctly. Prof Eralp, describing the diagnosis process in orthopedic cancers, said, “Since orthopedic cancers are rare, it is always necessary to suspect the unexpected. We try to obtain clues from the patients to try to reach the correct diagnosis with unthinkable questions.” After listening to the patient’s story, we try to reveal what this mass is, from the simplest Xray/ultrasound imaging to the most advanced technological MR/PET imaging. Finally, a tissue sample is taken (biopsy) by entering the potential tumoral tissue with a needle, and it is examined by a pathologist who is specialized in this field. We try to reach the correct diagnosis with the sample examined under the microscope. When all these steps are completed, the planning of the patient’s treatment begins. If a benign tumor is detected, recovery can be achieved with a correctly performed surgery. If a malignant tumor is detected, chemotherapy and radiotherapy should be added to the treatment before or after surgery, or both.
Correct Surgery is Important in Orthopedic Cancers
The duty of the orthopedist in tumor surgery is to perform the surgery correctly. Correct surgery means removing the tumor from the patient in a way that does not allow the disease to recur. Sometimes, the tumor may need to be removed along with the surrounding capsule or intact tissue. In healthy tissue, sometimes healthy muscles, vessels, nerves, and joints can be found. Whatever is left behind to save the patient’s life and limb, it should not be thought of as the patient’s limb working as much as possible. Thinking otherwise paves the way for the patient to develop recurrences or metastases in the future. The aim is to remove the tumor from the body with intact borders first. How to bridge or repair the gap formed after the tumor is removed is planned in the second stage. At this stage, plastic surgeons will work with soft tissue transplantation, cardiovascular surgeons with vascular grafts, and orthopedists with mega prostheses or regenerative tissues to create functional (i.e. moving) limbs for the patient. These surgical methods are very difficult as they are both long-lasting and require serious planning. At the same time, it should be taken into account that these patients are coming out of heavy chemotherapy and radiotherapy sessions. Since the bodies of these patients are open to many complications, their surgeries should be planned correctly and followed closely. The physician must have one hand on the patient. If the oncoming storm is not noticed, it will destroy everything when it comes.
Orthopedic Oncology is the most difficult branch of orthopedics!
After completing his education as an Orthopedic Specialist at Istanbul University, he received training on total joint prosthesis in Germany, external fixation and Ilizarov in Atlanta, and biological reconstruction in Japan, and still accepts patients in Acıbadem Healthcare Group with the title of Professor. He said that it is the most difficult, most unpredictable branch, the boundaries of which are drawn by scientific studies and open to creativity with past experiences. He said that it is a branch where patient follow-up should be done strictly.
Professor Levent Eralp, who is also an instructor in scuba diving, which he is engaged in as a hobby, said that just like in orthopedic oncology surgery, the rules of scuba diving should be well planned and strictly followed. He stated that if the rules are not set well or not followed, it will be very easy for disasters to occur both during the treatment process of orthopedic cancers and during diving.
Success Brings Happiness
Professor Eralp talked about his patient. They met because of a bone cancer that she was diagnosed with at the age of 8, and mentioned that the patient was operated on by himself after going through an intense chemotherapy period and recovered, and that she continued her life without any problems until the age of 18. He said that at the age of 18, when bone growth was complete, an expected result of the treatment occurred, that is she developed a shortness of 8.5 cm in one leg and she needed to have lengthening surgery. 6 months later after the operation, she brought her fiancé to meet Dr Eralp. He realized that he had not only saved her life with the first operation, but he understood that she had also been negatively affected socially due to the height difference. The next contact with the patient was established to find out if the pregnancy had a negative effect on the treatment process. When the patient became pregnant, Dr Eralp said that she would have no problems. Finally, seeing his patient with her baby in her arms made him very emotional and he said that he was happy to be the father of the baby’s name.
While most of the patients with tumors in their extremities have their arms or legs amputated, today this rate is done when it is very necessary and it only constitutes 5 percent of the patients. Success in orthopedic oncology is determined by survival rates within 5 years. While this rate was 10-15 percent in the past, it is around 60-65% today.
This success is due to the increase in the experience of orthopedists in limb-sparing surgeries and the increase in the success of the (reconstructive) methods that complete the gaps. Of course, the successful contributions of oncologists in the chemotherapy and radiotherapy treatments of the patient during this treatment process should not be forgotten. Although the experience is less than other types of cancer, we are much more successful in orthopedic cancers than 20 years ago.
Professor Levent Eralp stated that he enjoyed determining the surgical method to treat by making detailed calculations to solve many orthopedic problems. He underlined that they started accepting patients by establishing a unit within the Acıbadem Healthcare Group where only comprehensive extremity reconstruction studies would be done.
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