title: Limb salvage surgery for children and adolescents with malignant bone tumors in a developing country.
abstract: OBJECTIVE
  To describe the 5-year experience of a multidisciplinary limb salvage program for children and adolescents with malignant bone tumors in Lebanon.
  
  
  METHODS
  Between January 2002 to February 2007, 30 children and adolescents (2 with Ewing sarcoma and 28 with osteosarcoma) underwent Limb Salvage Surgeries (LSS) at the American University of Beirut Medical Center after partnering with the multidisciplinary team at St. Judes Children's Research Hospital (SJCRH). Procedures performed included 12 Repiphysis, noninvasively expandable, prostheses inserted in skeletally immature children, 15 modular prostheses, 2 allografts and 1 rotationplasty. All patients received pre- and postoperative chemotherapy.
  
  
  RESULTS
  With a mean follow-up of 31 months, 20 patients are now off therapy, 4 died, and 6 are receiving chemotherapy (3 due to pulmonary recurrence). Complications of surgery included infections in three cases, failure of the expansion mechanism in two, femoral stem fracture in one, prostheses femoral stem loosening in one and wound dehiscence in one. Lengthening of Repiphysis prostheses was achieved by subjecting the limb to an electromagnetic field that would allow controlled release of the Repiphysis expansion mechanism. Ten patients underwent a total of 42 lengthening procedures with an average of 9 mm lengthened per procedure (range 2-15 mm). All patients have good function of the affected limb.
  
  
  CONCLUSIONS
  Our LSS results are comparable to those reported in the literature. Collaboration with SJCRH and fund raising were critical to the program's success. This endeavor could serve as a model for establishing LSS programs in developing countries.
authors.affiliation: Children's Cancer Center of Lebanon, American University of Beirut-Medical Center, Beirut, Lebanon. rh00@aub.edu.lb
authors.forename: Rachid
authors.initials: R
authors.lastname: Haidar
authors.forename: Said
authors.initials: S
authors.lastname: Sagghieh
authors.forename: Samar
authors.initials: S
authors.lastname: Muwakitt
authors.forename: Ghina
authors.initials: G
authors.lastname: Mumtaz
authors.forename: Samir
authors.initials: S
authors.lastname: Akel
authors.forename: Rami
authors.initials: R
authors.lastname: Kamzoul
authors.forename: Roula
authors.initials: R
authors.lastname: Farah
authors.forename: Peter
authors.initials: P
authors.lastname: Noun
authors.forename: Hassan
authors.initials: H
authors.lastname: Khalifeh
authors.forename: Fadi
authors.initials: F
authors.lastname: Farhat
authors.forename: Bassem
authors.initials: B
authors.lastname: Razzouk
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez Galindo
authors.forename: Bhaskar
authors.initials: B
authors.lastname: Rao
authors.forename: Miguel R
authors.initials: MR
authors.lastname: Abboud
mesh_terms: D000293:Adolescent; D000328:Adult; D001852:Bone Lengthening; D001859:Bone Neoplasms / Q000601:surgery*; D002648:Child; D003906:Developing Countries; D005121:Extremities / Q000601:surgery; D005260:Female; D006801:Humans; D007861:Lebanon; D023821:Limb Salvage; D008297:Male; D012516:Osteosarcoma / Q000601:surgery*; D012512:Sarcoma, Ewing / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult