Limbsparing

Limb-sparing, or limb-sparing surgery, refers to surgical approaches that remove diseased tissue while preserving as much of the affected limb as possible. It is most commonly used for musculoskeletal tumors of the limbs, such as bone and soft tissue sarcomas, but can also apply to severe infection or trauma where salvage is feasible. The aim is complete tumor excision with negative margins while maintaining function and appearance of the limb.

Techniques involve resection with wide or radical margins followed by reconstruction to restore stability and function. Reconstruction options include endoprosthetic replacement, allografts or autografts, vascular reconstruction if major vessels are involved, nerve repair or grafting, and soft tissue coverage such as muscle flaps. External fixation or limb-lengthening methods may address instability or discrepancies in limb length after resection.

Selection criteria focus on achieving oncologic control with clear margins and a functional limb after reconstruction. Suitable cases typically have disease confined to the limb, reconstructible neurovascular status, and no distant metastases or prohibitive comorbidities. In some infections, chronic osteomyelitis with a viable soft tissue envelope may also be considered for limb salvage.

Outcomes and follow-up vary by tumor type and location. When feasible, limb-sparing procedures can provide oncologic control comparable to amputation in selected patients and may preserve proprioception and some degree of function. However, risks include infection, prosthetic or graft failure, nonunion, wound complications, and tumor recurrence, necessitating ongoing surveillance and rehabilitation.

Limitations and alternatives include cases where margins cannot be safely achieved or functional preservation would be poor. In such situations, amputation remains an important option. Decision-making typically involves a multidisciplinary team and patient preferences.