What Is Limb Salvage?

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Limb salvage is a surgical procedure to save a limb (usually one of the lower extremities) that is at high risk of amputation. The need for limb salvage can result from several different underlying causes, including various types of trauma, diabetes, vascular disease, cancer, or neuropathy.

The primary goal of limb salvage is to maintain or restore the persons’ stability as well as the ability to walk. The exact mechanisms of intervention may differ considerably depending on the underlying cause of the potential loss of a limb, the severity of the causative condition, and other factors.

limb slavage

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Types

When considering the anatomical features involved in medical conditions that may require a limb salvage, it’s important to keep in mind that there are many different reasons that a limb needs to be saved. These may include:

Bone cancer

The primary aim of limb salvage in a person with bone cancer is to remove a tumor with minimal complications and perform reconstructive surgery—when necessary—to maintain the appearance, durability, and functionality of the limb.

Saving a limb that has been impacted by bone cancer can be challenging, depending on many different factors, such as:

  • How the tumor responds to chemotherapy, radiation therapy, or other interventions aimed at shrinking the tumor
  • How large the tumor is
  • How much the tumor has spread to nearby tissues
  • How much bone tissue must be removed to eliminate a high risk for metastasis
  • If a bone graft is needed

Once the tumor has been reduced in size and surgically removed, reconstructive limb salvage surgery can begin.

Limb salvage and reconstructive surgery can include:

  • Reconnecting blood vessels
  • Replacing major blood vessels
  • Replacing muscles that have been removed (due to cancer)

Nerve grafts or repair of nerves may also be needed when nerves are affected by the tumor growth. But, considering all of the factors that need to be addressed in those with bone cancer who require limb salvage, reconstruction of missing bone is one of the biggest challenges.

Reconstruction of missing bone may include using:

  • Endoprosthesis: Internal metal parts surgically inserted to replace bone that was removed due to cancer.
  • Allograft bone: Using donated bones that have come from a donor, originating from bone tissue that has been preserved after a person is deceased.
  • Tissue regeneration: The process of renewal, growth, and repair of tissue that was damaged by the tumor.

Innovative new tissue regeneration treatment is beginning to emerge in the medical field, which utilizes a person’s own cells combined with synthetic matrix materials and protein growth factors to help bring on the regeneration of a person’s own tissue.

Diabetic Neuropathy

When a person has neuropathy, particularly diabetic neuropathy, it often leads to the need for amputation of a limb (usually a leg). This occurs because of a sequence of events including:

  1. High blood glucose (sugar) levels, which lead to nerve damage
  2. Nerve damage lowers a person’s sensation in the limbs (it usually starts in the feet).
  3. A lack of sensation in the lower extremities can cause unnoticed injuries which often progresses to skin ulcers or infections.
  4. Diabetics often experience poor wound healing; once an infection gets started in the foot, it often progresses and may require a surgical procedure to remove the infected area, or in the worst-case scenario, amputation is needed unless the limb can be salvaged.

Peripheral Arterial Disease (PAD)

Peripheral arterial disease (PAD) causes a reduction in blood flow to the limbs, usually occurring in the legs. The reduced blood flow caused by PAD can progress to a condition called critical limb ischemia (CLI), which can result in poor wound healing and severe pain in the leg or foot; it can even cause gangrene.

Limb salvage involves a group of treatments that may need to be performed to save the limb in a person with CLI, these interventions may include:

  • Angioplasty and stenting: A minimally invasive surgical procedure aimed at restoring blood flow through a blocked or narrowed artery.
  • Atherectomy: A minimally invasive surgical procedure used to remove plaques from the narrowed blood vessels; atherectomy is a less invasive alternative to angioplasty.
  • Bypass: Using autogenous vein, or a synthetic tube to bypass a blocked or narrowed blood vessel. This allows blood to circulate freely around the blocked area, thereby delivering vital oxygen and nutrients to the ischemic area.

Trophic Ulcer

A trophic ulcer is a pressure ulcer caused by external trauma to part of the body that has been impacted by disease such as from:

  • Malnutrition
  • Immunodeficiency
  • Vascular insufficiency
  • Loss of sensory nerve fibers

When limb salvage is implemented for the treatment of a trophic ulcer, it may involve providing a stable walking surface (particularly when necrotic foot ulcerations are present). 

Critical Limb Ischemia

Critical limb ischemia is considered a syndrome (a set of associated symptoms) caused by ischemia (inadequate blood supply to part of the body, which results in lack of proper oxygenation). Peripheral artery disease is a common condition that may cause critical limb ischemia.

Critical limb ischemia may cause symptoms including:

  • Pain
  • Tissue loss
  • Ulcers that will not heal properly
  • Gangrene

Critical limb ischemia creates a very high risk of losing a limb. The primary goal of limb salvage surgery for critical limb ischemia is to restore blood flow to the affected area using minimally invasive endovascular techniques or an open method of vascular surgery. 

The decision to save a critically injured limb usually involves a multidisciplinary team of health care professionals who consider many different factors, making a very individualized decision along with a precise treatment plan.

Medical Field

There is a very wide range of specialists who may be involved in the goal of saving a person’s limb. This multidisciplinary team involved in preserving function to a limb while helping a person avoid getting an amputation may include:

  • Foot and ankle surgeons: Responsible for removing infected tissue when applicable, also perform reconstructive surgery when lower extremity deformities are present.
  • Orthopedic specialty surgeons: Surgeons who specialize in the musculoskeletal system.
  • Vascular surgeons: Sub-specialty surgeons who perform procedures such as endovascular surgery (like angioplasty) to help promote the healing of wounds and surgical sites by improving blood flow problems.
  • Infectious disease specialists: Manage treatment such as the administration of microbial therapy.
  • Internal Medicine Specialists: Manage underlying medical conditions that contribute to a high risk of amputation such as diabetes, kidney, or heart disease.
  • Endocrinologists: Specialize in the treatment of diabetes and help patients maintain normal blood glucose levels, which promotes better wound healing.
  • Plastic surgeons: Perform specialized reconstructive surgery for very large wounds or tissue defects in complex wounds (such as severe combat wounds).
  • Occupational and physical therapists: Help patients regain as much function as possible after surgery.

Health Insurance

When it comes to long-term expense, some sources report that limb salvage is more cost-effective than having an amputation. But, regardless of the long-term cost savings, much of the expense incurred in limb salvage is not covered by insurance.

A 2018 study found that those included in a group that had low economic status were more likely to have an amputation than those with good insurance coverage.

Another study of 10 medical facilities in different parts of the United States, involving 566 people with Medicare insurance coverage, most of which underwent arterial reconstructive limb salvage procedures, found that all 10 centers had monetary losses for those who had limb salvage.

While limb salvage can be cost-effective in the long run, it’s important to check with your insurance provider to make sure that your surgery will be covered.

Treatment

The outcome for limb salvage differs based on case.

Bone Cancer

Limb salvage does not impact the survival rate in those with a specific type of cancer called limb sarcoma. It is the primary treatment choice—over amputation—in 95% of the cases.

Bone Cancer in Children

Bone sarcoma—a group of cancers that affects the bone and connective tissue—in small children can interrupt the child’s normal growth. This is particularly true when the tumor is around the knee, where it can interfere with critical growth plates in the lower limb.

A 2020 study involved 45 children with bone sarcoma of the knee area, underwent limb salvage surgery involving endoprosthesis.

The survival rate and functional outcomes (including the impact on growth) were recorded. At the 5-year mark, after surgery, the overall survival rate was 72.7% and the cancer-free survival rate was 54.9%.

The limbs were measured at the 5-year mark, 20 patients were discovered to have limb length discrepancies within just 2 cm (0.79 inches). The children were found to have good functional results as well.

Peripheral Arterial Disease (PAD)

A 2014 study aimed at evaluating the success/outcome of 202 people with 229 limbs with PAD. Some of the patients incurred PAD in both legs.

Endovascular surgery was implemented as the initial plan of treatment in 198 limbs. A total of 31 study participants underwent bypass surgery and another 16 people had an endovascular intervention that resulted in unsatisfactory results: these people underwent bypass surgery after the failed endovascular procedure. 

Surgical procedures to obtain the goal of limb salvage included:

  • Endovascular surgery
  • Angioplasty revascularization
  • Bypass surgery

The study results revealed that the amputation-free survival rates were 75.5% at one year and 57.6% at two years. The study concluded that the first approach, minimally invasive endovascular surgical methods (such as angioplasty) for PAD, could result in a satisfactory limb salvage rate.

Limb Salvage for Acute Limb Ischemia Due to Trauma

Trauma, causing vascular injury, can lead to acute limb ischemia (ALI), which is a condition that is linked with a high morbidity (illness) rate.

A 2020 study looked at the outcome of limb salvage in those who underwent revascularization for traumatic ALI. Although there was a very high rate of limb salvage procedures performed, the study found that good functional outcomes were not attained.

Functional outcomes included regaining function, like being able to stand or walk on the salvaged limb after surgery. This means that the complex injuries in those who underwent limb salvage for trauma, was not very conducive to successful outcomes in the functionality of the salvaged limb. This was particularly true when trauma patients underwent multiple operations. 

A Word From Verywell

At Verywell Health, we understand that undergoing limb salvage surgery can present a major crossroad in a person’s life. It’s important to do your research to get as much of an understanding of the surgical process and the medical terminology related to your condition, as well as learning about every available treatment option.

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