Limb Salvage Surgery

Just like how the name sounds, it literally means a surgery that rescues the limb.  As scary as it may sound, sometimes it might be the best viable option. Limb-sparing surgery or limb salvage surgery is a surgical procedure to remove a tumor in patients with bone cancer or soft tissue sarcoma. It is a highly specialized procedure as an alternative to amputation.

A few years back bone cancer or soft tissue sarcoma would have meant an amputation. This was mainly because the risk of the cancerous cells being left behind and there was no practical reconstruction of the limb for acceptable function after the tumor had been removed. However, with the years that passed by, it heralded drastic advances in technology were resorting to amputation needn’t be the only option.

The primary objective of this surgery is to remove the tumor while still keeping the nearby tendons, nerves and blood vessels so that patient can maintain mobility in the affected limb. During the procedure, the surgeon removes the tumor as well as some of the healthy surrounding tissue. If part of a bone is removed during this time, it is replaced often using synthetic metal rods, prostheses, or pieces of bone (allografts). Soft tissue and muscle from other parts of the body are then used to close the wound. Over time, the replacement bone fuses with the original bone, making limb movement possible.

There are a few options available for the replacement of large segments of missing bone. These options are grouped into the following categories:

Allograft bone replacement

Allograft bone replacement involves using bones that have been preserved from persons who have died.

Endoprosthesis

Metal endoprosthesis (metal replacement) have revolutionized the field of limb salvage. Prostheses can be implanted with or without bone cement.

Tissue regeneration

It involves a patient’s own cells, synthetic matrix materials and purified protein growth factors to regenerate the patient’s own tissue.

Fusion of a joint

When there is not enough muscle around a joint, the surgeon may recommend making the joint rigid by having the ends of the joint heal together.

Each technique of the procedure has its own advantages and disadvantages. Allografts may develop early complications but are less likely to require further surgery in the future. In comparison, an endoprosthesis has a lower risk of early complications but may require additional surgery over time. The lifespan of these prostheses are limited to an average of 15 years, sometimes even less.

Like every other surgery, there are some risks the patient needs to be aware of after the surgery. Some of which are:

  • Nonunion of bones: In the procedure, the portion of bone removed is replaced with donated bone. Nonunion occurs when the replaced bone does not heal, making fracture more likely, especially if the area is stressed.
  • Limb-length mismatch: Since the reconstructed section of bone cannot grow, a limb-length discrepancy may occur.
  • Prosthetic loosening: Sometimes the implanted joint may loosen or wear out, especially in people who are active.
  • Contractures: After the procedure, muscles, tendons, and ligaments sometimes stiffen or shrink which are more likely to occur in people who are not physically active.
Now that all the basics, risks and types of the procedure is covered it is also important to keep a few things in mind even after the surgery like:
  • Follow up visits to the doctor
  • Appropriate exercises to maintain limb function.
  • Any swelling, pain, redness or other infections at the surgical area have to be checked as soon as possible.
  • Due to a life-long risk of infection, be wary of any other surgical procedures
  • The metal implants may create a problem while security screening, so it always a good idea to carry a medical letter stating that you have had the metal implant.
  • Even though life after the surgery will never be as normal as before, the procedure brings hope to the people who thought amputation may be their only option. With the right attitude, this procedure shine light to a better future for people with bone cancer and soft tissue sarcoma.