Also known as limb-sparing surgery, limb salvage surgery is the procedure performed to remove bone cancers and soft-tissue in the limbs.
The surgery is performed so amputation is avoided.
What are some of the key goals of limb salvage surgery?
Limb-sparing surgery is done to:
- Remove cancer cells
- Avoid amputation
- Preserve the patient’s appearance
- Maintain the greatest degree of function (of the affected limb)
While limb salvage surgery is often done in the case of tumors and sarcomas, the procedure is also performed when there are soft tissue sarcomas affecting the extremities.
Over the years, limb salvage surgery has become the preferred option over amputation.
It is also the likely resort for cancers that have not yet invaded the soft tissues.
Decades ago, the typical treatment approach for patients with cancer in the limbs is amputation (of the extremity affected). Fortunately, nowadays, treating the cancer does not have to involve losing the limb.
This development can be attributed to significant factors such as enhancements in surgical techniques (both resection and reconstruction), current imaging methods available (CT scans and MRI), and survival rate of patients treated using chemotherapy.
Limb salvage surgery has also become a likely resort for individuals with bone diseases (rheumatoid arthritis) and those with chronic degenerative joint conditions.
Nowadays, limb-sparing surgery has also become a treatment alternative for likely candidates of diabetic limb amputation.
What key factors are considered before limb salvage surgery is deemed apt?
- Location of the cancer
- Type of cancer
- Size of the cancer
- Patient’s overall health
- Patient’s age
- Progression of the cancer
If the procedure is recommended, the likely outcome will be explained—implant failure is a possibility and further surgery (or amputation) may be necessary in some instances.
Physical and occupational therapists will prepare limb salvage surgery candidates through muscle-strengthening exercises and ambulation (walking).
Range of motion (ROM) exercises will also be recommended.
How is the procedure carried out?
The procedure involves removing the cancer and an inch of the healthy tissue surrounding it.
Chemotherapy, radiation, or both might be recommended (to shrink the tumor) before surgery is performed.
In essence, the 3 stages of limb salvage surgery are:
- Cancer (and a margin of healthy tissue) is removed.
- Prosthesis is implanted or bone graft is performed when necessary.
- Wound is closed (using soft tissue or muscle from other parts of the body).
What are the surgical techniques employed in limb salvage surgery?
Soft tissue sarcomas–a whopping 80 percent of soft tissue sarcomas affecting the extremities are treated with limb salvage surgery. The procedure entails removing the lymph nodes and the tumor. Tissues where the cancer has spread will also be removed.
Bone tumors – when treating low-grade bone tumors (as well its components), the malignant lesion as well as a cuff of healthy tissue will be removed.
If the soft tissue sarcoma has spread to the lung, the original tumor will be removed. The lung tumor will be shrank using chemotherapy or radiation and the lung tumor will be surgically removed.
What are the expected (typical) aftercare regimen post-surgery?
After the surgery, patients are expected to remain in the hospital for at least 5 to 10 days. Sensation and blood flow of the affected extremity will be monitored closely.
Possible signs of complications (i.e. deep-vein thrombosis, pneumonia, and pulmonary embolism) will also be checked.
The first 48 hours post-surgery, broad spectrum antibiotics will be prescribed. Antiembolism stockings and medications (prophylactic anticoagulants) will also be given. This is to keep blood clots from forming.
For the first 24 to 48 hours, drainage tube will be placed in the wound to keep blood and fluid from accumulating.