Limb Salvage Surgery in Bangalore

Limb Salvage surgery can be a blessing for people who have malignant tumours or sarcomas in the bone, soft tissues and bone metastasis. Earlier, if a patient had a malignant tumour, it mostly meant that they would need an amputation. However, with the development of Limb Salvage surgical treatment, people can now preserve their limbs and their functionality.

How is Limb Salvage Surgery performed?

Limb Salvage Surgery procedure involves surgical removal of the sarcomatous (cancerous) tissue arising from bone or soft tissue with adequate normal tissue margins followed by personalised reconstructive methods (tumour prosthesis/ biological/ composite reconstructions). Reconstructive methods usually involve placing an implant which can either be a bone graft or a metal prosthesis.

Types of Limb Salvage Procedures at Apollo Hospitals

There are now different types of limb salvage surgeries being performed that can help people with different types of malignant tumours of the bone. Here are some Limb Salvage procedures that can be successfully done for bone sarcoma patients:

• Tumour Megaprosthesis Reconstruction
• Expandable/Growing Tumour Prosthesis for Children
• Biological Reconstruction
  • Bone Autograft
  • Bone Allograft
  • ECRT (Extracorporeal radiation & Reimplantation)
  • Vascularised Fibula
  • Cryotherapy
• Graft Prosthetic Composite Reconstruction
• Internal Hemipelvectomy and Reconstruction
• 3D printed Model and Implant Surgery
• Nail/Plate Cement Spacer Reconstruction
• Ulna Translocation & Wrist Arthrodesis
• Scapulectomy and Reconstruction
• Tumour Excision & Flap reconstruction
• Rotationplasty

Advantages of Limb Salvage Surgery

Limb Salvage surgery has several advantages over amputation or other modalities as a definitive treatment for sarcomas. This is especially true due to the availability of navigation assistance, 3D printed surgery, and custom prosthetic designs to maximise the functional outcome. Here are some benefits of Limb Salvage surgery:

1. The major advantage of this procedure is the preservation of the limb and its function. While amputation leads to people losing their entire limb and learning to live without it, limb salvage surgery can help people keep their limbs with some level of functioning.
2. Statistics show that limb salvage surgery provides better gait efficiency and return to normal living compared with amputations.
3. Limb salvage surgery has also been shown to be more cost-effective than amputations in the long run.

It is for these reasons that doctors prefer limb salvage surgery over amputations in more than 95% of sarcoma cases.

Limb Salvage Surgery Procedure at Apollo Hospitals

Before the Procedure

The doctors will initially run tests and evaluate the patient to see if they are eligible for the procedure. Patients may be asked to stop taking certain medications a few weeks prior to the surgery. Physical therapy may be started a few weeks before the surgery. Patients will be instructed about how the surgery will be conducted and how they must prepare for it. It is advised that patients arrange for someone to be with them before and after the procedure. They may also be asked to fast before the surgery.

During the Procedure

During the surgery, the doctors will first remove the sarcomatous (cancerous) tissue arising from bone or soft tissue with adequate normal tissue margins. They will then begin the reconstruction of the limb. The reconstruction may be done by placing a metal implant (prosthesis) or bone from another part of the body or from someone else (bone graft). The reconstruction method may differ depending on the type of procedure the patient is getting.

After the Procedure

After the surgery, the doctors will provide detailed instructions about how to take care of the wound and care to be taken during the postoperative recovery period. Patients may experience pain and swelling at the surgery site. They will be given medications to help with the recovery. In some cases, patients may be required to protect the extremity for six weeks from major forces such as full weight-bearing. Patients will also require physical therapy for crutch use, range-of-motion, and strengthening.

Recovery Period

Recovery for every patient will be different depending on the bone lesion and location. On average, the patient will take around a month or more to completely heal and start with their work.

Who is eligible for Limb Salvage Surgery?

Although limb salvage surgery has several advantages over amputation, it may not be possible to perform it in all cases. Not all sarcoma patients are eligible candidates for this type of procedure. Limb salvage surgery is an option in cases wherein the following conditions are met:

• Limb functionality should be better after the surgery as compared to amputation and prosthesis.
• There is a chance to preserve major motor and sensory nerves during the surgery.
• The surgery could preserve adequate muscle function.
• The surgery should allow restoring major blood supply to the area.

In addition to these, the doctors will need to evaluate every patient based on their current condition, age, health, medical history and any existing medical conditions to see if they are eligible for the procedure.

Risks Associated with Limb Salvage procedure

Limb Preservation or Salvage surgery is a major procedure and, like every surgical procedure, carries a risk of certain side effects and complications. Common side effects and complications associated with limb salvage surgery include:

1. Risk of infection
2. Periprosthetic fracture
3. Prosthetic loosening or dislocation
4. Nonunion of the graft-host junction
5. Allograft fracture
6. Leg-length discrepancy
7. Needing additional revision surgery as the lifespan of prostheses is limited to an average of 15 years or even less.

Limb Salvage surgery is a complicated procedure and should only be performed by trained sarcoma specialists and a surgical team experienced in performing such procedures successfully. Apollo Hospitals, Karnataka, has the best doctors with years of experience in successfully performing such complex surgeries, as well as world-class medical facilities and technologically advanced infrastructure to aid in such complex procedures.