Limb Salvage Surgery for Bone & Soft Tissue Tumors

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What is Limb Salvage Surgery?

Limb salvage surgery encompasses all surgeries performed to remove bone or soft tissue tumour and reconstruction of the limb with an acceptable oncologic, functional and cosmetic result. 

What are the Aims of Limb Salvage Surgery?

1) To achieve complete removal of sarcoma from an oncological point of view

2) To reconstruct the defect, and thereby maximised the function taking into consideration the age, size and socio-economic status of the individual

3) To allow adjuvant therapy to be provided to prevent oncological failure.

Who are the candidates for Limb Salvage?

A multidisciplinary approach, Effective chemotherapy, Expertise of treating surgeon and Modern techniques in Complex reconstruction has allowed nearly every individual suffering from sarcoma to be considered a candidate for limb salvage surgery.

In what stage is Limb Salvage Surgery possible?

The patient’s sarcoma prognosis has some impact on the decision to perform limb salvage. Presently, limb salvage is possible in nearly 90-95 % of sarcomas. The earlier the stage, the better is the result. Limb salvage can even be performed in stage IV or metastatic situation for palliative means.

Are there conditions when Limb Salvage cannot be Performed?

  1. Extensive growth or involvement involving the blood vessels and nerves which is irreparable

  2. Improperly performed extensive biopsy techniques performed without the idea of limb salvage

  3. Presence of infection or severely immunocompromised status. 

Pathological fractures and vascular involvement which can be repaired can still undergo limb salvage surgery, in select individuals.

What are the tests done before Limb Salvage Surgery?

If you will visit the top orthopedic hospital in Bangalore, The step-wise timely, coordinated multi-disciplinary approach to sarcoma which requires limb salvage is as follows:

  1. Clinical history and physical examination.

  2. Imaging techniques such as X-ray, MRI, CT Thorax

  3. Biopsy with or without image guidance performed preferably by the Musculoskeletal Oncosurgeon who performs limb salvage.

  4. Staging involves PET CT (FDG/NaF) or Bone scan with CT scan of the chest.

  5. Personalised approach after multi-disciplinary tumour board discussion

  6. Patient education and counselling 

  7. Neo-adjuvant chemotherapy

What are the Types of Limb Salvage?

  • Tumour Megaprosthesis

  • Growing/Expandible Megaprosthesis in children

  • Massive Bone Allograft

  • Autograft 

  • Extra-corporeal Radiation & Reimplantation

  • Arthrodesis with Massive Bone Allograft/Autograft

  • Allograft Prosthesis Composite (APC)

  • Intercalary segmental prosthesis

  • Hemipelvectomy & reconstruction

What is the function of Limb Salvage Surgery?

Limb salvage surgery is recommended over amputation in the majority of bone sarcoma situations due to the inherent advantage of a preserved, functional limb. The resultant functional outcome of the limb salvage is often related to the extent of the removal of sarcoma and the technique employed in reconstruction. 

Mega prosthetic reconstructions allow functional joint movement, suitable for routine daily activities, thereby enabling them to walk with full weight on the operated limb within a few days.

Biological reconstructions involving the lower limb and pelvis require a long period of limited weight-bearing mobilization to allow the bony union. 

What are the complications associated with Limb Salvage Surgery?

  1. Deep peri-prosthetic infection

  2. Failure of muscle and soft tissue cover

  3. Aseptic loosening, fracture of components, wear & tear of bushing components

  4. Delayed union, Non-union or fracture of bone graft, Implant failure

  5. General complications involved in all major limb and pelvic surgeries such as neurovascular injury, deep vein thrombosis, pulmonary embolism and perioperative blood loss.

Consult with a good orthopedic doctor in Bangalore to know more about Limb Salvage Surgery.

Dr Srimanth B S
Consultant – Orthopaedic Onco Surgery
Manipal Hospitals Bangalore – Old Airport Road

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