Combined Surgical Team Approach for Limb Salvage: To Avoid Amputations in Skin, Vessels, or Nerve Involvements in Bone and Soft Tissue Tumors

Abstract Background: The involvement of skin with or without fungative mass, open biopsy scar or previous unplanned surgeries with poor surgical scar, and involvement of neurovascular structures along the bone and soft tissue were the contraindications for limb salvage surgeries. The recent indications of limb salvage had established the role of microscopic negative surgical margins to improve outcomes. The combined surgical team with plastic surgery and vascular surgery can extend the indications by increasing the spectrum of reconstruction after resection of primary malignancies with safe surgical margins. Materials and Methods: A total of 42 cases, aged from 7 to 75 years (mean = 41.9 years) were operated from February 2017 to August 2021 at Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India, included for retrospective study. The male-to-female ratio was 24:18. All cases were considered for surgical excision of tumors with safe surgical margins as per standard. Patients who did not receive any kind of reconstruction for nerve, vessels, or skin defect and achieved primary closer or amputations were excluded from the study, whereas 33 patients received skin defect, 6 patients vascular defect, and 3 cases considered for microscopic nerve dissection were included in the study. All included cases considered for reconstruction of defects with combinations of plastic and vascular surgery teams. Results: All patients were analyzed for functional improvement, survival, and feasibility of adjuvant treatment. 11 ( n = 11) patients lost follow-up, four patients died due to distant metastasis within 12 months ( n = 2) of surgery, two cases died after 12 months ( n = 2), and one died due to other cause ( n = 1). In the remaining 26 patients, the mean follow-up was 61.1 months (36–84 months). A total of 23 patients completed neoadjuvant and adjuvant therapy ( n = 23) according to histopathology. Functional assessment was done with Musculoskeletal Tumor Society Score (MSTS) score, 24 patients under follow-up achieved MSTS score of 25–30 at 12 months follow-up ( n = 24). Conclusion: Combinations of surgical procedures for reconstructions of skin, vessels, or nerve defects can extend the indications of limb salvage in bone, soft tissue, and skin malignancies without affecting the surgical principles for tumor excision with safe surgical margins. The proper planning and selection of procedures according to the requirement of adjuvant therapies can maintain overall survival along with aesthetic limbs to improve the functional and social requirements of patients.