Limb Salvage Surgery

What is limb salvage surgery?

Limb salvage surgery, also known as limb sparing surgery, is a surgical procedure to remove diseased parts of the bone (such as cancer) and replace them with metal implants, bone grafts from another person, or reconstructions using tissue regeneration.¹² This procedure is offered as an alternative to amputation and can be used in conjunction with radiation therapy and/or chemotherapy. A medical specialist called an orthopaedic surgeon performs limb salvage surgery.

When should I or my loved one see a specialist for limb salvage surgery?

Limb salvage surgery is an option for patients who are faced with the possibility of losing a limb, as a result of a malignant tumour, a traumatic injury, rheumatoid arthritis, or diabetes-related complications. You, or your loved one, will be referred to an orthopaedic surgeon if your extremities are threatened with amputation.

Did you know?

Ninety percent of limbs afflicted by tumors can be saved by limb salvage surgery techniques.¹

What are the risks of limb salvage surgery?

The main risks associated with limb salvage surgery include the following³:

● Adverse reaction to anaesthetic.
● Post-operative infection of the surgical site.
● Loosening or breaking of the implant.
● Rapid loss of blood flow or sensation in the limb.
● Severe blood loss and anemia.
● Failure of surgery (which occurs in a small percentage of patients).

How should I prepare for my appointment?

Our orthopaedic surgeons at Mount Elizabeth Medical Centre will assess your condition and treatment options before deciding whether it is appropriate for you to undergo limb salvage surgery. After taking all contributing factors into consideration (age, general health, type of cancer or injury, progression of your condition) and making a decision, your surgeon will explain the procedure and possible outcomes, in detail.

Prepare for your appointment by assembling your medical history and a list of current medications as well as compiling any questions/concerns that you may have in relation to your surgery. It is advisable to bring a support person to the appointment too.

What can I expect during limb salvage surgery?

Limb salvage surgery is performed in three stages:

● Removal of the tumour, affected tissue, and a margin of surrounding healthy tissue.
● Implantation of a prosthesis or bone graft to replace the parts of bone removed.
● Closing of the wound by transferring healthy soft tissue and muscle from another part of the body.

You will require general anaesthesia and a breathing tube during your surgery. You will be monitored very carefully by your healthcare team throughout the procedure.

What happens after my limb salvage surgery?

Following your surgery, you will be carefully monitored in hospital for at least 5-10 days⁴. Your health care team will be making sure that blood flow reaches the extremities and that sensation returns. Antibiotics and anticoagulants will be administered and attention taken to detect any possible complications such as infection, blood clots in the legs or lungs and pneumonia. Before leaving the hospital, you will receive clear instructions on how to maximise your recovery and protect yourself from infection. You may also require walking aids, such as a cane or a walker.

Once discharged from hospital, you will need to follow physical rehabilitation therapy, based on your individual case, for a minimum of 12 months. The objective of this occupational and physical therapy is to work on the freedom of movement and function, as well as the issue of body image⁵.

Selected Specialist Publications
[1] Chen CM, Disa JJ, Lee HY, Mehrara BJ, Hu QY, Nathan SS, Boland P, Healey J, Cordeiro PG. Reconstruction of extremity long bone defects after sarcoma resection with vascularized fibula flaps: a 10-year review. Plast Reconstr Surg. 2007 Mar;119(3):915-24
[2] Nathan SS, Guerzon ER, Bhavanam K, Tan LH, Zarchi K, Pereira BP. Collagen membranes for host-implant integration: a pilot clinical study. J Orthop Surg (Hong Kong). 2011 Aug;19(2):157-63.
[3] Nathan SS, Athanasian E, Boland PJ, Healey JH. Valgus ankle deformity after vascularized fibular reconstruction for oncologic disease. Ann Surg Oncol. 2009 Jul;16(7):1938-45. doi: 10.1245/s10434-009-0485-6.
[4] Nathan SS, Gorlick R, Bukata S, Chou A, Morris CD, Boland PJ, Huvos AG, Meyers PA, Healey JH. Treatment algorithm for locally recurrent osteosarcoma based on local disease-free interval and the presence of lung metastasis. Cancer. 2006 Oct 1;107(7):1607-16.
[5] Nathan SS, Lee HY, Disa JJ, Athanasian E, Boland P, Cordeiro PG, Healey J. Ankle instability after vascularized fibular harvest for tumor reconstruction. Ann Surg Oncol. 2005 Jan;12(1):57-64. Epub 2004 Dec 27.

A/Prof Saminathan Suresh Nathan
Orthopaedic Consultant
Limb Salvage and Revision Arthroplasty Surgery Pte Ltd
Mount Elizabeth Medical Centre