Limb Salvage Surgery for Bone Cancer
Before the turn of the century, most of the cancers to the extremities, involving bones in particular, had invariably led to amputation, leaving the patient cripple for the rest of his life. Any trial to save the limb had either risked leaving the tumor behind or left no plausible choice for reconstructing the limb with acceptable function.
Thanks to the boom in technology, now it is feasible to safely treat malignant limb tumors without resorting to limb amputations. This can be done without hindering any major functional outcomes.
What is Limb Salvage surgery?
Surgery that is done to address malignant tumors of the limb by only removing the lesion, involved bone and surrounding soft tissue, without sacrificing the limb. When the limb is sacrificed, it is termed as amputation. A limb salvage surgery is aimed at better functional outcomes than the amputations.
One of the major challenges in limb salvage procedure is to reconstruct the lost bone and establish the continuity. There exist various options to reconstruct the bone.
Commonly used options are
Allograft Bone Replacement:
This involves using bones of dead persons who have donated their organs and tissues. The person who receives the allograft has his bones grow into it, healing and partly replacing it. Infection, graft fractures are the major complications.
Advent of endoprosthesis has revolutionised the limb salvage surgeries. The lost bone is replaced by an inert metal, usually titanium to reconstruct the lost bone. Major disadvantage of these endoprosthesis is that they have a limited life for about 10-15 years and are most likely to be replaced.
This is the next evolving thing in the field of Limb salvage surgery. Newer concepts of tissue engineering where combination of patient’s own cells, synthetic matrix materials and purified protein growth factors are used to fill in for the lost bone and tissues.
The function of the reconstructed limb primarily depends on the strength of the muscles around the joint. It is also vital to establish the blood supply and the nerve innervation to the distal stump for the limb to be viable and functional.
Scenarios that can lead to amputation in an otherwise limb salvage patient
- Pathological fracture
- Improperly done previous biopsy
- Irresponsible curettage of the lesion leading to tumor dissemination to surrounding soft tissues
- Disease progression on chemotherapy
Gone are the days when every patient with malignant bone tumors of extremities were left with no other option than to lose their limb. With the arrival of various limb salvage techniques very few patients need amputations in this era.