Limb Salvage

What is limb salvage surgery?

Limb salvage surgery is surgery to repair and restore (salvage) a limb (an arm or leg) that’s critically diseased or injured. It’s an attempt to save your limb when amputation would be the alternative.

Limb salvage surgery is also called limb-sparing surgery. These are just different ways of saying that your surgeon will try to prevent you from losing your limb, without compromising your overall health.

What conditions can limb salvage surgery treat?

Limb-sparing surgery may be an option if you have bone cancer or soft tissue sarcoma in an arm or leg. A surgeon will carefully determine if they can remove the cancerous tumor without sacrificing your limb.

If you have a critical injury to an arm or leg, your surgical team will evaluate the injury to determine if they can salvage your limb. Salvage might mean repairing, replacing or reconstructing different parts.

Limb salvage surgery is a common treatment for:

• Bone sarcomas, like osteosarcoma, Ewing sarcoma and chondrosarcoma.
• Soft tissue sarcomas, including liposarcoma, myxofibrosarcoma and leiomyosarcoma.
• Metastatic bone cancer (cancer spread from somewhere else to the bone) resulting in a fracture or impending fracture.
• Severe infections of the bone (osteomyelitis), joint (septic arthritis) or soft tissue (gangrene).
• Traumatic injuries.

What are the criteria to have limb salvage surgery vs. amputation?

Surgeons considering limb salvage surgery vs. amputation want to ensure that the surgery can succeed. A successfully salvaged limb is free of disease, works as it should and has an acceptable cosmetic result.

Whether this is possible for your limb will depend on the specifics of your condition, including:

• Extent of disease. If a tumor is too big or has grown into the surrounding structures, it may not be possible to remove it without damaging important functional parts. Similarly, if an infection has spread too far or caused too much damage, it may not be possible to save your limb.
• Extent of injuries. Surgeons use scoring systems to rate the severity of injuries that have damaged your nerves, tissues, blood vessels or bones. They’ll need to replace what they can’t repair. If too many parts are beyond repair, they can’t replace them all individually. They’ll also need to be sure they can restore blood flow to all of your tissues. Without it, tissues will die.

What happens before limb salvage surgery?

Before limb salvage surgery can happen, you may need:

• Pre-operative treatment. If you have critical injuries, you might need more immediate treatment to stabilize your condition before it’s safe for you to have major surgery. If you have cancer, your healthcare team might want to treat it with chemotherapy or radiation therapy prior to surgery. This can potentially shrink the tumor and make it easier to remove.
• Pre-operative assessment. Your healthcare team may need to use various tests to assess your condition, including imaging tests to examine your limb, like an MRI or CT scan, and tests that examine your blood flow, like a CT angiogram or Doppler ultrasound. They’ll also consider your overall health, including preexisting conditions that might affect the success of the surgery.
• Pre-operative discussion. Whenever possible, your team will discuss the surgery with you before proceeding. They’ll explain what they plan to do, the risks and challenges ahead and the potential outcomes, and ask for your informed consent. Deciding between limb salvage surgery and amputation can be difficult. Take time to consider the options and ask questions.

What happens during limb salvage surgery?

Limb salvage surgery begins with removing disease if you have any. That might mean removing an infection or a tumor. Once your limb is free of disease, the reconstruction process begins.

There may be many steps to reconstruction, and it may take place over multiple surgeries. Surgeons may have to reconnect, repair or replace blood vessels, nerves, bones and other tissues.

Your surgery might involve:

• Revascularization. If you’ve lost blood flow to part of your limb, your surgeon will need to restore it. Surgeons use vascular surgery techniques to repair vessels and restore blood flow.
• Microsurgery. Your surgeon might need to replace a piece of vascular tissue or nerve tissue with a piece from a donor or your own body (a “flap”) and then connect the blood vessels or nerves.
• Grafting. Your surgeon might need to take a piece of bone (bone graft) or skin (skin graft) from a donor or your own body and use it to replace a damaged or missing part of your limb.
• Prosthesis. Your surgeon might use metal implants to replace or repair a bone or a joint to restore the functionality of your limb. Some prosthetics combine metal with a bone graft.
• Bone transport. To fill in or lengthen long bones, your surgeon may apply a stainless-steel fixator system (like the Taylor Spatial Frame or Ilizarov apparatus) that stimulates bone growth.

What happens after limb salvage surgery?

Most people will need extensive physical rehabilitation after limb salvage surgery. A physical therapist will work with you to exercise your limb and restore its range of motion to the extent possible.

This part will require time, effort, patience and persistence to succeed. In some cases, it can take longer to restore function to a salvaged limb than it would take to learn to use a new, prosthetic limb.

What are the pros and cons of limb salvage surgery over amputation?

Potential advantages of limb salvage surgery include:

• Better limb functionality and walking gait.
• Better cosmetic result (more normal physical appearance).
• Equal or better quality of life and survival rate.

Potential disadvantages include:

• Longer rehabilitation.
• Salvaged limbs may need more follow-up care.
• Higher likelihood of needing revision surgeries.

What are the risks or complications of limb salvage surgery?

Risks include:

• Infection.
• Wound healing complications.
• Failure of the surgery and the need to amputate.
• Complications with prosthetics, which might break or loosen.
• Return of the disease or condition that endangered your limb.

How long is the recovery from limb salvage surgery?

Your recovery time will depend on which parts of your limb were salvaged and how they were reconstructed. Wounds typically heal within weeks, but muscles and bones can take months to heal.

In general, you’ll spend several days in the hospital after limb salvage surgery and then two to three months recovering at home before returning to work or school. It may take longer to recover the full use of your limb.

Can you walk after limb salvage surgery?

The typical goal of limb salvage surgery on a leg would be to save it for this very purpose. While your surgeon will expect you to walk again, how long it will take will be different in each individual situation.

Similarly, how well you walk — whether you’ll have a limp or whether you’ll be able to walk as far and as fast as before — will depend on specifics. You should discuss your expectations carefully with your surgeon.

What is the success rate of limb salvage surgery?

The success of limb salvage surgery depends on the reason for doing it and the extent of the disease or injury. Functional outcomes can vary by where the disease is located and the method of reconstruction.

Studies show that in appropriately selected patients in treatment for bone cancer, long-term survival rates and quality of life scores are comparable between limb salvage surgery and amputation.