Limb Salvage Surgery

What is limb salvage surgery?

Limb salvage surgery is a complex, limb-preserving procedure most used in the treatment of bone and soft tissue sarcomas.

It involves removing bone or soft tissue tumours — most often sarcomas — while preserving as much function and appearance of the affected limb as possible. This approach is considered a key alternative to amputation in managing certain types of cancer, particularly those affecting the arms or legs.

In addition to cancer, limb salvage surgery may also be used in selected cases of severe diabetic foot complications, where tissue damage or infection threatens limb viability. In such cases, the goal is to avoid amputation by removing affected tissue and reconstructing the limb to restore stability and function.

This surgery is used in both adults and children, though it is especially significant in paediatric and adolescent patients, where preserving growth and mobility is crucial. The aim is always to remove the diseased tissue, reconstruct the affected area, and retain the limb’s structural integrity and function.

How it works

Limb salvage surgery involves the complete removal of the cancerous tumour, along with a margin of surrounding healthy tissue to ensure all malignant cells are removed. Following this, reconstruction is carried out using:

• Endoprostheses (internal metal implants)
• Bone grafts (from the patient or a donor)
• Soft tissue reconstruction (using muscle or skin flaps)
• Or a combination of these methods

The procedure may require a multidisciplinary team of orthopaedic surgeons, oncologists, plastic and reconstruction surgeons, radiation oncologists, interventional radiologists, and rehabilitation specialists.

Why do you need limb salvage surgery?

Limb salvage surgery is typically recommended if:

• You have a primary bone or soft tissue tumour, such as osteosarcoma or Ewing sarcoma, especially located in the limbs.
• The cancer is localised and has not spread extensively to surrounding nerves, blood vessels, or distant organs.
• You are a suitable candidate for complex reconstructive surgery.
• Your medical team determines that complete tumour removal with clear margins is achievable without compromising limb function beyond recovery.

This approach offers a function-preserving alternative to amputation, which was historically the only option for limb tumours. It can greatly improve quality of life by maintaining mobility and body image, especially in younger patients.

Who should not undergo limb salvage surgery?

You may not be a suitable candidate for limb salvage surgery if:

• The tumour has extensively invaded major nerves, blood vessels, or surrounding tissues, making safe removal without amputation impossible or leaving the limb non-functional.
• There is widespread metastasis (cancer spread to other parts of the body), where local surgery will not improve overall prognosis.
• You have a high risk of surgical complications, such as poor general health, severe infection, or conditions that impair wound healing (e.g. uncontrolled diabetes).
• An infection is present in the tumour site or nearby tissues, which may compromise reconstruction success.
• Expected function after reconstruction is minimal, where amputation with a prosthetic limb may provide better mobility and quality of life.
• You are not medically fit or willing to undergo intensive rehabilitation, which is essential for recovery and regaining function.

What are the risks and complications of limb salvage surgery?

As with all major operations, limb salvage surgery carries risks, particularly due to its complexity. These may include:

• Infection at the surgical or reconstruction site
• Delayed wound healing or tissue breakdown
• Implant or graft failure
• Nerve damage, leading to weakness or numbness
• Bleeding
• Incomplete tumour removal / progression of the disease
• Functional limitations, depending on the extent of tissue removed

In some cases, complications may lead to the need for a secondary procedure, or in rare cases, delayed amputation if salvage is no longer viable.

What can you expect during a limb salvage surgery?

Limb salvage procedures are lengthy and may take 4 – 10 hours, depending on the complexity of tumour removal and reconstruction.

Before the procedure

You will be admitted to hospital and seen by your surgical and anaesthetic teams. A final surgical plan will be confirmed, and general anaesthesia will be administered.

During the procedure

The tumour and the margin of surrounding tissue will be carefully surgically removed.

Reconstruction of the bone, joint or soft tissue will follow, using a custom implant, graft, or muscle flap, depending on the defect. Vascular and nerve structures may be preserved or repaired where feasible.

A drain may be placed to prevent fluid build-up post-operatively.

After the procedure

You will be moved to the recovery area or intensive care, depending on your condition. A surgical drain and dressing will be in place, and pain management will be provided.

Physical therapy may begin within days to encourage mobility.

Common short-term side effects may include:

• Pain and swelling
• Stiffness or weakness in the affected limb
• Limited movement, depending on the surgical site

Care and recovery after a limb salvage surgery

Total recovery varies but can last up to 6 – 12 months, including rehabilitation. Most patients start rehabilitation the day after surgery, and can eventually walk or use their arm again, though not always at pre-surgery levels.

Recovery tips

• Attend regular physiotherapy to regain strength and function
• Monitor surgical wounds for signs of infection
• Adhere to weight-bearing restrictions as advised (especially if implants or bone grafts were used)
• Use mobility aids such as crutches, slings or braces if needed
• Follow up regularly with your surgical and oncology team to monitor healing and cancer control

Recovery will depend on several factors, including the extent of previous treatment and tissue damage, your overall health and age, pre-existing urinary or erectile issues, and how well you follow post-operative advice.