In essence, limb salvage surgery is the kind of procedure done to remove bone and soft-tissue cancers in the limbs.
The procedure is carried out so amputation is avoided.
Goals
Aside from avoiding amputation and removing the cancer, limb salvage surgery is also carried out in order to retain the greatest degree of function available and maintain the patient’s appearance.
While the surgery is often done for bone tumors and bone sarcomas, it is also performed on individuals with soft tissue sarcomas.
Many years ago, the standard care for those patients with cancer in the limbs would often involve amputation of the extremity affected.
Fortunately, thanks to dramatic improvements in imaging methods and surgical techniques, patients no longer have to lose a limb in order to treat the cancer.
Over the years, limb salvage surgery has become the treatment option for patients with chronic degenerative bone and joint diseases like rheumatoid arthritis, those patients who are candidates for diabetic limb amputation, and those with acute and chronic limb wounds.
Procedure
Also referred to as limb-sparing surgery, limb salvage surgery involves removing the cancer and an inch of the healthy tissue surrounding it.
If the bone has also been removed, it will have to be replaced.
The replacement can come from a donor body (cadaver) or from the body of the patient (autologous transplant).
Eventually, the transplanted bone will grow into the remaining bone.
Chemotherapy, radiation, or a combination of both will be used to shrink the tumor before the procedure is carried out.
The operation is done in three stages.
Surgeons will remove the cancer first as well as a margin of the surrounding tissue, a prosthesis or a bone graft is implanted when necessary, and the wound is closed by transferring soft tissue and muscles from other parts of the patient’s body.
Surgical Techniques
Soft tissue sarcomas
Limb salvage surgery is carried out on at least 80 percent of soft tissue sarcomas affecting the extremities.
The surgery will involve removing the tumor, lymph nodes, and the tissues where the cancer has spread.
An inch of the healthy tissue that surrounds the tumor will also be removed.
If the soft tissue sarcoma has spread to the lungs, the doctor will remove the original tumor, administer radiation or chemotherapy treatments, and then surgically remove the tumor.
Bone tumors
The malignant lesion and a cuff of normal tissue is removed in the treatment of low-grade tumors alongside any of its components.
In the case of high-grade tumors, bone, muscles, and tissues that are affected will also be removed.
Radiation and chemotherapy may be administered prior or after the surgery.
Radiation may also be administered during the procedure itself.
A special applicator will be placed against the surface where the tumor has been removed.
A tube with radioactive pellets will be exerted at the site of the tumor.
The tubes will have to be removed after several days.
Aftercare
After the surgery, blood flow and sensation in the affected extremity will be closely monitored.
Nurses will also need to watch out for possible signs of complications like pneumonia, deep-vein thrombosis, and pulmonary embolism.
Patients will also be given broad-spectrum antibiotics during the first 48 hours after the surgery.
Antiembolism stockings and prophylactic anticoagulants may also be recommended to ensure no blood clots are formed.
During the first 24 to 48 hours, a drainage tube will be placed in the wound to ensure blood and fluid do not accumulate.
The moment the postoperative pain is less severe, mild narcotics and anti-inflammatory medications will be given.
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