Surgery STAT: Limb sparing: less common procedures
The scapula, like the distal ulna, can be removed and not replaced. As a general rule, the amount removed and the size of the dog are inversely related to the degree of limb function and speed of recovery that one might expect. A complete scapulectomy can be performed if necessary. The prognosis for functional outcome remains good to excellent for most dogs. Physical rehabilitation can make a tremendous difference in the final functional outcome.
Two techniques are described for use in the distal tibia: distraction osteogenesis and microvascular transfer of a distal ulnar graft (Photos A and B). Distraction osteogenesis as previously described in the radius also works well for the tibia. Using two bone segments, allowing for more rapid transport and restoration of the bony column, also is reported.
Stereotactic radiosurgery and intensity-modulated radiation therapy (IMRT) are "non-surgical" modalities that have the ability to deliver high doses of radiation to the tumor while sparing normal tissues. These techniques have the potential to be very useful in cases in which maintenance of limb function is necessary for an acceptable quality of life. Unfortunately, they are not readily available to veterinarians at this time.
In conclusion, many techniques are available for limb sparing, each with advantages and disadvantages. Limb sparing requires significant planning, skill, case selection and follow-up on the part of the veterinary team. Just as important is solid owner commitment. Client education and cooperation are imperative for a good outcome.
Dr. Bernard Séguin is an ACVS board-certified surgeon who is an assistant professor at the College of Veterinary Medicine, Oregon State University. His research interests include osteosarcoma and limb sparing.