Limb Salvage Surgery

Limb salvage surgery is a type of surgery primarily performed to remove bone and soft-tissue cancers occurring in limbs in order to avoid amputation .Limb salvage surgery is performed to remove cancer and avoid amputation, while preserving the patient's appearance and the greatest possible degree of function in the affected limb. The procedure is most commonly performed for bone tumors and bone sarcomas.

Also called limb-sparing surgery, limb salvage involves removing the cancer and about an inch of healthy tissue surrounding it. In addition, if had been removed, the removed bone is replaced. The replacement can be made with synthetic metal rods or plates (prostheses), pieces of bone (grafts) taken from the patient's own body (autologous transplant), or pieces of bone removed from a donor body (cadaver) and frozen until needed for transplant (allograft). In time, transplanted bone grows into the patient's remaining bone. Chemotherapy, radiation, or a combination of both treatments may be used to shrink the tumor before surgery is performed.
Limb salvage is performed in three stages. Surgeons remove the cancer and a margin of healthy tissue, implant a prosthesis or bone graft (when necessary), and close the wound by transferring soft tissue and muscle from other parts of the patient's body to the surgical site. This treatment cures some cancers as successfully as amputation.

Before deciding that limb salvage is appropriate for a particular patient, the treating doctor considers what type of cancer the patient has, the size and location of the tumor, how the illness has progressed, and the patient's age and general health.

After determining that limb salvage is appropriate for a particular patient, the doctor makes sure that the patient understands what the outcome of surgery is likely to be, that the implant may fail, and that additional surgery—even amputation—may be necessary.

Physical and occupational therapists help prepare the patient for surgery by introducing the muscle-strengthening, ambulation (walking), and range of motion (ROM) exercises the patient will begin performing right after the operation.

During the five to 10 days the patient remains in the hospital following surgery, nurses monitor sensation and blood flow in the affected extremity and watch for signs that the patient may be developing pneumonia, pulmonary embolism, or deep-vein thrombosis.

The doctor prescribes broad-spectrum antibiotics for at least the first 48 hours after the operation and often prescribes medication (prophylactic anticoagulants) and antiembolism stockings to prevent blood clots. A drainage tube placed in the wound for the first 24–48 hours prevents blood (hematoma) and fluid (seroma) from accumulating at the surgical site. As postoperative pain becomes less intense, mild narcotics or anti-inflammatory medications replace the epidural catheter or patient-controlled analgesic pump used to relieve pain immediately after the operation.