Transtumoural plating - any experiences

RE: Transtumoural plating - any experiences

Nhombokisheni — Tue, 12 Apr 2016 21:46:10 GMT

[quote user="Malcolm Ness"]

It seems perverse in the face of concerns about the dog's ability to cope on three legs to subject it to a procedure whose convalescence depends upon the dog being able to get around on three legs while the fourth returns to function. It seems equally perverse to start on a surgery whose convalescence is six months or more in response to a disease whose survival time is broadly similar.

[/quote]

Here is a paper on limb sparing:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2034429/ as you say the authors acknowledged that " Amputation has traditionally been the most common treatment for appendicular osteosarcoma (2,3,5). This procedure usually ensures complete removal of the primary tumor and provides pain relief, relatively short anesthesia times, decreased risk of postoperative complications, and decreased expense in comparison with limb-spare procedures".

Secondly, it's interesting that with such a high metastatic rate (98%) and the fact that by the time of dx there will be spread anyway, there is no way of removing the primary tumour completely with limb sparing.........because of "tumor cells infiltrating the entire medullary cavity".

I totally agree that limb amputation is way better an option.

On chemo which is your best option in terms of MST.

RE: Transtumoural plating - any experiences

Malcolm Ness — Tue, 12 Apr 2016 19:04:53 GMT

[quote user="Thomas Johnson"]recommend them for giant breed dogs which are considered less likely to cope well with amputation due to their size and weight.[/quote]

Jolle Kirpensteijn did some work many years ago that did not support the suggestion that bigger dogs do less well as tripods.

Limb sparing surgery is one of the relatively few procedures that I would never perform on a dog of my own and consequently, I won't do it to anybody else's dog until such time as there is a better way of killing the cancer.

RE: Transtumoural plating - any experiences

Thomas Johnson — Tue, 12 Apr 2016 14:31:15 GMT

[quote user="Malcolm Ness"]

The surgery is substantial and associated with very high rates of complication and failure. Almost all dogs treated in this way go on to die of their disease - local recurrence; orthopaedic failure or metastatic disease if excision and orthopaedics has been good. Any extension to life expectancy over that expected to follow amputation is debatable (selection criteria for limb-sparing tends to select the 'best' cases).

My view is that until we have access to better ways of killing the tumour, then such procedures are difficult to justify.

[/quote]

My understanding is that those orthopaedic surgeons who carry out the limb-sparing techniques tend to recommend them for giant breed dogs which are considered less likely to cope well with amputation due to their size and weight. Still not sure whether they are a good idea or not though.

RE: Transtumoural plating - any experiences

Malcolm Ness — Tue, 12 Apr 2016 08:34:24 GMT

[quote user="Michael Woodhouse"]I forget the details now, but Matthew Pead of the RVC told us about a large breed dog with a bone tumour where he removed a chunk of bone - somehow sterilised and replaced it in the dog and it was miraculously fixed.[/quote]

So called 'limb salvage' surgery has been played with over the last couple of decades. That involves resecting the bone tumour and placing implants across the defect. Inevitably, the surgery involves a pan-carpal arthrodesis as well as addressing the large volume deficit with a bone graft of some kind. Most often a standard portico-cancellous bone graft is used but synthetic and allografts have been tried.

My view is that until we have access to better ways of killing the tumour, then such procedures are difficult to justify.

RE: Transtumoural plating - any experiences

Michael Woodhouse — Mon, 11 Apr 2016 22:55:13 GMT

I forget the details now, but Matthew Pead of the RVC told us about a large breed dog with a bone tumour where he removed a chunk of bone - somehow sterilised and replaced it in the dog and it was miraculously fixed.

RE: Transtumoural plating - any experiences

Nhombokisheni — Mon, 11 Apr 2016 19:01:26 GMT

Glad I'm not the only one who was taken aback by this. Can this be classified as ethical research or it borders on welfare for the reasons you advanced. As you can see there is no way that plate could neutralise all the forces around that tumour.

RE: Transtumoural plating - any experiences

Malcolm Ness — Mon, 11 Apr 2016 11:38:53 GMT

Surprising and a bit worrying.

To my mind, this is largely cosmetic surgery. There might be some pain relief associated with immobilising the pathological fracture, but against that there is pain associated with the surgery plus pain associated with fixing the (still intact) carpal and carpo-metacaarpal joints.

It is well recognised that amputation offers effective pain relief in these cases and if surgery was considered, then that would be the way to go.

The orthopaedic surgery is a concern: a single plate of that size applied to this case would be inadequate in terms of immobilising this site. The failure by pull-out of the distal screws was predictable.

RE: Transtumoural plating - any experiences

David Mills — Fri, 08 Apr 2016 12:07:09 GMT

Seriously?