Researchers aim to grow replacement bone for people injured by landmines
BMJ 2017; 356 doi: https://doi.org/10.1136/bmj.j23 (Published 04 January 2017) Cite this as: BMJ 2017;356:j23All rapid responses
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Whilst the research project into the creation of bone scaffolds for reconstructive surgery following injury is welcomed, the application of this technology in landline amputees would seem limited and many years from clinical application.
The photograph used to illustrate the article would seem to be illustrative; rather than being in need of more bone it would appear that the child's below knee stump is of excess length, and furthermore compromised by poor soft tissue coverage distally. Bone scaffold would seem to have very little role, but revision surgery might produce real benefits in terms of function and mobility.
Bone scaffold technology, if and when clinically available , will probably find its main place in the inventory of cost intensive techniques available for limb reconstruction in the developed world. The chances of it ever being affordable or deliverable in the less developed world, where most victims of anti-personnel landmines reside, are remote. Might not this £2.8million pound investment have been made in a field more likely to directly asset landline victims such as surgical care or prosthetic provision?
Competing interests: No competing interests
Growing bones for whom and for what?
Dear Editors
I agree entirely with Dr Mannion's response
As much as it is heresy for an orthopaedic surgeon to say this, bone/defect damage is not the most important issue of concern when considering the management of lower limb blast injury:
Physiological and Chronological age of patient
Mangled Extremity Severity Score
Soft Tissue Cover
Presence of Infection
Integrity of Nerve function (sensory, then motor)
Ability to benefit from faster rehabilitation from amputation vs protracted staged reconstructive management
appropriately summarised as the following indications for amputation:
"Dead / Dying / Dangerous / Damn nuisance"
(Orthopaedic surgeons are not generally known for tactfulness within the medical circle)
I suspect this technology will ultimately end up as a first world luxury for a long time before more landmine victims see the benefits of this research.
Competing interests: No competing interests