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Palliative reconstructive surgery: contextualizing palliation in resource-poor settings.

Nthumba PM - Plast Surg Int (2014)

Bottom Line: Surgical training does not arm the surgeon with the skills needed to deal with the care of palliative patients.Resource constraints demand that the surgeon be multidiscipline trained so as to be able to adequately address the needs of a growing population of patients that could benefit from surgical palliation.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Plastic, Reconstructive and Hand Surgery Unit, AIC Kijabe Hospital, Kijabe 00220, Kenya.

ABSTRACT
Introduction. Palliative care in Kenya and the larger Sub-Saharan Africa is considered a preserve of hospices, where these exist. Surgical training does not arm the surgeon with the skills needed to deal with the care of palliative patients. Resource constraints demand that the surgeon be multidiscipline trained so as to be able to adequately address the needs of a growing population of patients that could benefit from surgical palliation. Patients and Methods. The author describes his experience in the management of a series of 31 palliative care patients, aged 8 to 82 years. There were a total of nine known or presumed mortalities in the first year following surgery; 17 patients experienced an improved quality of life for at least 6 months after surgery. Fourteen of these were disease-free at 6 months. Conclusion. Palliative reconstructive surgery is indicated in a select number of patients. Although cure is not the primary intent of palliative surgery, the potential benefits of an improved quality of life and the possibility of cure should encourage a more proactive role for the surgeon. The need for palliative care can be expected to increase significantly in Africa, with the estimated fourfold increase of cancer patients over the next 50 years.

No MeSH data available.


Related in: MedlinePlus

(a) Posterior trunk sarcoma following 3 previous resections. Wide excision, including part of the scapular. Reconstruction using Latissimus dorsi muscle. (b) Same patient a year later. Normal shoulder function and no recurrence. Patient remains asymptomatic at 3 years.
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fig3: (a) Posterior trunk sarcoma following 3 previous resections. Wide excision, including part of the scapular. Reconstruction using Latissimus dorsi muscle. (b) Same patient a year later. Normal shoulder function and no recurrence. Patient remains asymptomatic at 3 years.

Mentions: Of the 31 patients, three had malignant peripheral nerve sheath tumors (2 retroperitoneal and one with extensive bony metastases from an arm lesion). Forty-two percent (11) of the patients had undergone one or more surgical procedures in other institutions; of these, 4 had had two or more attempted resections (Figures 2, 3, and 4).


Palliative reconstructive surgery: contextualizing palliation in resource-poor settings.

Nthumba PM - Plast Surg Int (2014)

(a) Posterior trunk sarcoma following 3 previous resections. Wide excision, including part of the scapular. Reconstruction using Latissimus dorsi muscle. (b) Same patient a year later. Normal shoulder function and no recurrence. Patient remains asymptomatic at 3 years.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4230194&req=5

fig3: (a) Posterior trunk sarcoma following 3 previous resections. Wide excision, including part of the scapular. Reconstruction using Latissimus dorsi muscle. (b) Same patient a year later. Normal shoulder function and no recurrence. Patient remains asymptomatic at 3 years.
Mentions: Of the 31 patients, three had malignant peripheral nerve sheath tumors (2 retroperitoneal and one with extensive bony metastases from an arm lesion). Forty-two percent (11) of the patients had undergone one or more surgical procedures in other institutions; of these, 4 had had two or more attempted resections (Figures 2, 3, and 4).

Bottom Line: Surgical training does not arm the surgeon with the skills needed to deal with the care of palliative patients.Resource constraints demand that the surgeon be multidiscipline trained so as to be able to adequately address the needs of a growing population of patients that could benefit from surgical palliation.Conclusion.

View Article: PubMed Central - PubMed

Affiliation: Plastic, Reconstructive and Hand Surgery Unit, AIC Kijabe Hospital, Kijabe 00220, Kenya.

ABSTRACT
Introduction. Palliative care in Kenya and the larger Sub-Saharan Africa is considered a preserve of hospices, where these exist. Surgical training does not arm the surgeon with the skills needed to deal with the care of palliative patients. Resource constraints demand that the surgeon be multidiscipline trained so as to be able to adequately address the needs of a growing population of patients that could benefit from surgical palliation. Patients and Methods. The author describes his experience in the management of a series of 31 palliative care patients, aged 8 to 82 years. There were a total of nine known or presumed mortalities in the first year following surgery; 17 patients experienced an improved quality of life for at least 6 months after surgery. Fourteen of these were disease-free at 6 months. Conclusion. Palliative reconstructive surgery is indicated in a select number of patients. Although cure is not the primary intent of palliative surgery, the potential benefits of an improved quality of life and the possibility of cure should encourage a more proactive role for the surgeon. The need for palliative care can be expected to increase significantly in Africa, with the estimated fourfold increase of cancer patients over the next 50 years.

No MeSH data available.


Related in: MedlinePlus