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Traumatic Limb Salvage Surgery

What is Traumatic Limb Salvage Surgery?

Limb salvage surgery, also called limb-sparing surgery, is a surgical procedure that involves debridement- removal of the injured bone and surrounding tissues and reconstructing them into a functional limb. This may be done using an allograft, a bone graft from donor, metal implant, or a combination of metal implant and bone graft called allograft-prosthetic composite.  Limb salvage surgery can be performed for your arms, legs or could also involve your hip joint.

What are the Indications for Traumatic Limb Salvage Surgery?

Limb salvage surgery is recommended for the following conditions:

  • Trauma caused due to motor vehicular accident or fall from a height
  • Removal of tumor in your limb or hip. The tumor should be small. For bigger tumors, amputation is preferred

Procedure for Traumatic Limb Salvage Surgery

You will be placed in supine position on your back and administered general anesthesia. 

  • An incision will be made in your arm, thigh or near your hip depending on the area of the limb to be operated upon.
  • The muscles in your limb are retracted. 
  • Your surgeon removes any injured tissue and damaged bone.
  • If only a small amount of tissue is removed, an autograft (healthy tissue removed from another part of the patient’s body) or an allograft (tissue taken from a deceased donor) can be used to reconstruct the surgical gap.  
  • The bone graft is shaped to the required size and attached to the bone with the help of metal rods and plates. 
  • If a joint reconstruction is required, the bones are either fused with a bone graft or a prosthesis may be fixed to the bone graft using plate and screws or bone cement.
  • The muscles and tendons are attached to the implant.
  • The surgical site is closed after covering the implant with healthy soft tissue. 

Post-operative Care after Traumatic Limb Salvage Surgery

The operated limb will be bandaged and immobilized using a splint to provide support and facilitate recovery process. 

  • You would be given pain-relief medications and broad-spectrum antibiotics to prevent an infection. 
  • You will be closely monitored for any signs of pulmonary embolism, deep-vein thrombosis or pneumonia. 
  • Physical therapy is initiated soon after your surgery and may continue for a year to regain muscle strength and functional mobility of the limb. 

What are the Risk and Complications of Limb Salvage Surgery?

The potential risks and complications associated with limb salvage surgery may include:

  • Infection
  • Blood clot
  • Loosening of implant
  • Limb length discrepancy, especially in growing children
  • Nonunion of bone and graft, due to improper healing
  • Recurrence of tumor 
  • Need for another surgery or amputation

What are the Benefits/Advantages of Traumatic Limb Salvage Surgery?

Traumatic limb salvage surgery offers the following benefits:

  • Provides stability to the limbs and hip joint
  • Offers sufficient wound coverage in trauma cases 
  • Salvaged limb is less affected by ongoing chemotherapy and radiotherapy
  • Preserves joint function and movements
  • Improves aesthetic outcome
  • Long-lasting results
  • Improved quality of life

What are the Developments in Traumatic Limb Salvage Surgery?

The safety and precision of traumatic limb salvage surgery can be enhanced using computer-assistance. This increases the accuracy of bone resection and preserves bone and joint function in anatomically challenging locations.

To further minimize technical errors during navigation-assisted bone tumor resection, surgeons may perform direct magnetic resonance imaging (MRI)-guided navigation surgery to develop images that help develop a patient-specific customized prosthesis.