During limb salvage surgery, surgeons try to save as much of your limb as possible instead of removing the entire limb. It’s used to treat tumors in your arms or legs.

Limb salvage surgery, also called limb-sparing surgery, is an alternative to complete amputation. It can help maintain your limb’s appearance and function while treating cancer.

The survival rates for people with cancer in their limbs have improved drastically in the last several decades. Many people who would have previously needed an amputation are now successfully treated with limb salvage surgery.

Surgeons also use limb salvage surgery to treat some infections or traumatic injuries, but here we focus on limb salvage surgery for cancer.

Limb salvage surgery is used to save the appearance of your limb while treating a tumor. It may be used to treat many types of cancer, such as:

Prior to the 1970s, amputation was the main surgery for many bone cancers such as osteosarcoma, chondrosarcoma, or Ewing sarcoma.

Advancements in treatment have significantly improved the survival rates for these cancers. Now, 90% of these tumors are treated successfully with limb salvage procedures.

The following are the four main types of limb salvage procedures: autograft, endoprosthesis, bulk allograft, and allograft prosthetic composite reconstruction.

Autograft

An autograft is the preferred treatment when possible. It involves using a part of your own body as a graft to help fill in the tissue removed during surgery. For example, your surgeon might use segments of bones from your:

  • hip
  • shin
  • rib

An autograft might not be possible if you:

  • have poor blood flow to the surgical area
  • have significant health complications
  • need to receive radiation therapy to the area as well

Endoprosthesis

An endoprosthesis is an artificial body part used to replace the part removed during surgery. It’s often made from metal alloys. Complication rates are high, however, and there’s a failure rate of about 25%.

Bulk allograft

Bulk allograft is used to treat large defects not treatable with prosthetic reconstruction. It involves using tissue from other individuals. Usually, this tissue comes from recently deceased cadavers.

Allograft prosthetic composite reconstruction

Allograft prosthetic composite reconstruction may provide better functional outcomes compared to an allograft alone. It involves using a combination of tissue transplanted from another person with prosthetic material.

Limb salvage surgery comes with risks, such as:

  • infection
  • loosening of a prosthetic part
  • failure of a graft to bind
  • breaking of a graft
  • tumor progression
  • graft-versus-host disease

Success rates for salvage surgery depend on the extent of your cancer and the body part treated. For example, total femur replacement has about a 48% 5-year survival rate, but replacement of the upper femur has about an 88% 5-year survival rate.

Nowadays, about 90% of tumors are treated successfully with limb salvage procedures, and 5-year survival rates have improved from 66% to 82%.

The procedure depends on what part of your body is being treated and the extent of the cancer. Here’s a general idea of what to expect.

Before the procedure

Before your procedure, your surgeon will brief you on what to expect and the potential risks. You’ll need to stop eating before your procedure. You’ll often need to avoid eating within 6 hours and drinking within 2 hours.

During the procedure

  1. A nurse will place a small tube into a vein in your hand or arm. General anesthetic will flow through this tube and put you asleep during your procedure.
  2. Once you’re asleep, your surgeon will make an incision into your limb. They’ll remove your cancer and an area of tissue around it to make sure that they completely removed it.
  3. If you had bone removed, they’ll then replace the bone with a prosthetic or another type of graft.
  4. Your surgeon will reconstruct your limb to help maintain its function and shape.
  5. They’ll close your wounds and cover them with bandages.

After the procedure

You’ll wake up in the recovery area after your procedure. You’ll likely need to spend at least a few nights in the hospital for monitoring.

You’ll need to have a pre-assessment before your procedure, where you’ll receive many tests, such as:

Limb salvage surgery can be a major procedure with a long recovery time. Depending on your type of cancer, you may need to receive chemotherapy, radiation therapy, or other treatments for weeks to months after your procedure.

Once your cancer treatment is complete, you’ll likely work with a physical therapist or occupational therapist to help build strength and mobility back in your limb. Most people achieve maximal recovery 2 to 3 years after surgery to treat soft-tissue sarcoma of the extremities.

People with surgery in their lower extremities need about 1 year on average to relearn how to walk.

If your cancer is too advanced to be treated with limb salvage surgery, you might need amputation. Amputation involves removing the entire limb.

Radiation therapy might be an alternative option if surgery can’t be performed.

Prices for limb salvage surgery can vary widely between operations. The price is influenced by factors like:

  • your geographic location
  • the surgical center where you receive your procedure
  • the type of procedure needed
  • the extent of your procedure
  • whether you develop complications

Many procedures cost tens of thousands of dollars to more than $100,000.

Insurance programs like Medicare often cover most or all of the cost, but they may not cover certain procedures if they’re considered experimental.

Limb salvage surgery is used to treat tumors in your limbs. It’s an alternative surgery to amputation that helps preserve the function and appearance of your limb. It may also be used to treat traumatic injuries and serious infections.

Many cancers that traditionally had to be treated with amputation can now be treated with limb salvage surgery. Your healthcare team can help advise you on whether you may make a candidate.