Limb reconstruction in a resource-limited environment

Abstract

Introduction: Limb salvage and reconstruction are often challenging and even more so in the limited resource setting. The purpose of this narrative review is to explore the strategies for addressing the unique obstacles and opportunities of limb reconstructive surgery in resource-limited environments globally. Methods: We review (1) the global burden and dimension of the problem, (2) the relevance of orthopedic forums and communication, (3) free and open-access software for deformity analysis and correction, (4) bidirectional learning opportunities, and the value of fellowships and mentoring between resource-rich and resource-limited countries, and (5) how societies like SICOT can help to tackle the problem. Finally, case examples are presented to demonstrate the choice of surgical implants, their availability in regions with limited resources, and how the universal principles of limb reconstruction can be applied, irrespective of resource availability. Results: Limb reconstruction can often be life-changing surgery with the goals of limb salvage, improved function, and ambulation. The contradiction of relatively few severe limb deformities in high-income countries (HICs) with abundant resources and the considerable burden of limb deformities in resource-limited countries is striking. Free, open access to education and software planning tools are of paramount importance to achieve this goal of limb reconstruction. Bidirectional learning, i.e., knowledge exchange between individual surgeons and societies with limited and abundant resources, can be reached via fellowships and mentoring. The presented cases highlight (1) fixator-assisted wound closure obliviating the need for plastic surgery, (2) open bone transport, and (3) hinged Ilizarov frames for correction of severe deformities. These cases underline that optimal clinical outcome can be achieved with low-cost and readily available implants when the principles of limb reconstruction are skillfully applied. Discussion: Limb lengthening and reconstruction are based on universally applicable principles. These have to be applied regardless of the planning tool or surgical implant availability to achieve the goals of limb salvage and improved quality of life.

Correction of Proximal Tibial Deformities using Ilizarov-Taylor Spatial Frame

“…Additionally, this fixator creates an optimal setting for the regeneration of new bone and the healing of soft tissues. Additionally, the computer software facilitates the streamlining of preoperative planning and the rectification of deformities that may arise after application [10] . So, the aim of this study is to assess the Ilizarov-Taylor Spatial Frame in the correction of the Proximal tibial Deformities.…”

German Translation and Cross-Cultural Adaptation of the Limb Deformity-Scoliosis Research Society (LD-SRS) Questionnaire

“…LD can arise from a variety of medical conditions (congenital or acquired due to trauma, tumor, infection as well as iatrogenic and idiopathic origin) [ 2 , 3 ]. Limb reconstruction is the art of treating LD and improving the functionality of the limb no matter the available resources [ 4 ].…”