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Limb Salvage Tumor Surgery (Limb-Preserving Reconstruction)

Wide en-bloc resection of primary or metastatic bone and soft-tissue sarcomas with simultaneous reconstruction using endoprosthetic megaprosthesis, allograft-prosthetic composite, vascularized fibula, or expandable prosthesis to preserve limb function in 80–90% of operable patients.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Ortopedi ve Travmatoloji department. Book Appointment →

What is Limb Salvage Tumor Surgery (Limb-Preserving Reconstruction)?

Limb salvage surgery (LSS) is the gold-standard surgical management of primary bone sarcomas and high-grade soft-tissue sarcomas in the extremities, replacing amputation as the dominant approach since the 1980s with comparable oncologic survival but markedly superior functional and psychosocial outcomes. Modern LSS is enabled by the integration of neoadjuvant chemotherapy (osteosarcoma, Ewing sarcoma), advanced imaging (MRI, PET-CT) for accurate margin planning, and engineered endoprosthetic systems.

Indications include primary bone sarcomas (osteosarcoma, Ewing sarcoma, chondrosarcoma, pleomorphic undifferentiated sarcoma of bone), high-grade soft-tissue sarcomas with bone invasion or critical neurovascular involvement that can be resected with negative margins, oligometastatic disease, and selected metastatic carcinoma to bone (renal, breast, thyroid). Contraindications include inability to achieve oncologic margins, encasement of major neurovascular bundle precluding limb function, infected pathologic fracture, or patient unable to tolerate complex reconstruction.

Reconstruction options are tailored to defect: (1) endoprosthetic megaprosthesis (proximal femur, distal femur, proximal tibia, total femur, proximal humerus, total humerus) — modular systems (GMRS, MUTARS, MEGASYSTEM-C) or 3D-printed custom; (2) allograft-prosthetic composite for younger active patients; (3) vascularized free fibula transfer for diaphyseal defects (humerus, ulna, radius, tibia); (4) expandable prosthesis (Repiphysis, Stanmore JTS, MUTARS XGrow, MUTARS Repiphysis) for skeletally immature children to maintain limb-length equality; (5) rotationplasty (Van Nes / Borggreve) for very young children with distal femoral or proximal tibial tumors; (6) recycled autograft (extracorporeal irradiation, pasteurization, liquid nitrogen freezing) in resource-limited settings.

Symptoms

Persistent deep bone pain, especially night pain or rest pain
Palpable mass, swelling, or visible deformity
Pathological fracture (acute or impending)
Limb weakness, numbness from neurovascular compression
Constitutional symptoms (weight loss, fever, fatigue) in advanced disease
Functional limitation of affected limb
Findings on imaging suggestive of malignant primary or metastatic bone tumor

Risk Factors

Pediatric age (osteosarcoma, Ewing sarcoma)
Hereditary syndromes (Li-Fraumeni TP53, retinoblastoma RB1, Werner, Rothmund-Thomson)
Prior radiation exposure to extremity
Paget disease, bone infarct, fibrous dysplasia (sarcomatous transformation)
Acquired immunosuppression (HIV, transplant)
Metallic implants in elderly patients (rare implant-associated sarcoma)
Familial chondromatosis (multiple osteochondromas → secondary chondrosarcoma)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent deep bone pain, particularly at night, unrelieved by rest
  • Painless or painful soft-tissue mass enlarging > 5 cm or deep to fascia
  • Spontaneous fracture or fracture with minor trauma
  • Visible swelling, deformity, palpable mass on extremity
  • Constitutional symptoms with limb pain
  • Imaging finding of aggressive bone lesion or large soft-tissue mass
  • Pathological diagnosis of bone or soft-tissue sarcoma

Treatment Methods

01
Multidisciplinary tumor board: orthopedic oncology surgeon, medical oncology, radiation oncology, pathology, radiology, plastic / vascular surgery as needed
02
Pre-op staging: contrast MRI of primary lesion (define tumor extent, neurovascular involvement), CT chest, PET-CT, bone scan
03
Image-guided core needle biopsy along planned future surgical approach (preserve biopsy tract for excision)
04
Neoadjuvant chemotherapy for high-grade osteosarcoma (MAP regimen: methotrexate, doxorubicin, cisplatin) and Ewing sarcoma (VDC/IE)
05
Wide resection with negative margins (Enneking wide); reconstruction tailored: endoprosthetic megaprosthesis (GMRS, MUTARS, MEGASYSTEM-C), allograft-prosthetic composite, vascularized free fibula, expandable prosthesis (children), rotationplasty (selected pediatric distal femur), or autograft (extracorporeal irradiation, pasteurization, liquid nitrogen)
06
Adjuvant chemotherapy and / or radiotherapy depending on histology and resection margins
07
Long-term oncologic and functional follow-up: MSTS, TESS, QOL scores; surveillance MRI, CT chest every 3–6 months for 2 years, then every 6–12 months; lifelong surveillance for late metastases and implant complications (infection, loosening, periprosthetic fracture)

Which Department to Visit?

You can visit our Ortopedi ve Travmatoloji department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.