LIMB SALVAGE SURGERY IN WASHINGTON, DC & FAIRFAX, VA
Limb Salvage Surgery
Do you recognize this infamous sack? In November of 2018, Redskin’s quarterback Alex Smith sustained a traumatic injury to his right leg during a game against the Houston Texans. Smith was carted off the field during the third quarter after getting sacked by the Texans’ corner back, Kareem Jackson, and defensive end, J.J. Watt. His diagnosis was a broken tibia and fibula, and was told he needed surgery as soon as possible. Smith’s injury is comparable to Joe Theismann’s infamous leg injury that occurred 33 years prior. Dominion Plastic Surgery’s own Dr. Mehan, Dr. Johnson, and team operated on his leg, performing reconstructive and salvage surgery. Dr. Mehan was the lead surgeon for Smith’s intricate procedure. Dr. Mehan, Dr. Johnson, Dr. West, Dr. Malekzadeh, and Dr. Holtzman are all of the surgeons who participated in his care to save his leg.
ESPN released this article, explaining the story of Alex Smith’s limb salvage operation:
About Limb Salvage Surgery
Just a couple of decades ago, if a patient had a malignant tumor in an arm or a leg it usually meant the limb would have to be amputated. The risks of potentially not removing all of the tumor, coupled without having the surgical means of reconstructing the limb, simply left few options for patients.
Fortunately, the last 20 years have brought dramatic advances in what is now known as limb salvage surgery. In these procedures, the goal is to safely remove the tumor without removing the limb.
Dr. Mehan and Dr. Johnson utilize their board-certified plastic and reconstructive surgery experience and training to offer these limb salvage surgeries for our Dominion Plastic Surgery patients.
What is Limb Salvage Surgery?
These are intricate surgical procedures where a tumor in the patient’s arm or leg is removed, but the limb is not amputated. The bone and tissue around the tumor will often also need to be removed to ensure complete removal without contaminating the surrounding area. This tissue and/or bone will then be replaced using different methods. They can be grouped into three general categories: reconstruction with allograft bone, reconstruction with metal parts, and reconstruction using tissue regeneration. Dr. Mehan and Dr. Johnson use microsurgical methods whenever possible with these reconstructions.
At What Point Would My Limb Need Salvage Surgery?
The goal of these procedures is to avoid amputation. This is not always possible but achieving stable bony union and adequate soft-tissue coverage is necessary to restore function in the limb. At Dominion, Dr. Mehan and Dr. Johnson weigh each patient’s situation, but the goal, if at all possible, is to salvage the limb. The question is usually if the tumor has grown into nearby structures or not.
What Are The Different Options Used For Limb Salvage Procedures?
As mentioned above, these surgeries can be grouped into three categories:
ALLOGRAFT BONE REPLACEMENT
These procedures rebuild bone that has been removed using donor bone or a piece of bone taken from another part of the body. When more bone is needed, this will usually need to come from donor sources. The patient’s remaining bone in the area will heal to the allograft (donor’s bone) and will grow into it. This will eventually replace part or most of the allograft.
ENDOPROSTHESIS
Implantable metal prostheses have completely revolutionized these surgeries. Metal endoprostheses must replace both the joint surface and a large section of the bone adjacent to the joint.
TISSUE REGENERATION
Tissue regeneration is another rapidly advancing area of these procedures. Tissue engineering uses combinations of the patient’s own cells, synthetic matrix materials, and purified protein growth factors to induce the regeneration of the patient’s own tissue. Nerves and blood vessels are moved. These are complex procedures and we used microsurgical methods for better outcomes.
FAQs
What Conditions Would Require Limb Salvage Surgery?
In most cases, children and adults who would need limb salvage procedures would have a malignant tumor in the limb. But these surgeries can also be necessary after trauma, with peripheral vascular disease, and in diabetic patients.
How Does A Person Prepare For Limb Salvage Surgery?
Obviously, if these are cases of trauma, there is no preparation, as the surgery is likely an emergency. Otherwise, preparation for limb salvage isn’t any different than for other major surgery. You’ll stop taking aspirin, blood thinners, anti-inflammatories medications, and most supplements at least one week prior to your surgery, as all of these can contribute to excessive bleeding. You’ll need to fast beginning at midnight of the prior evening.
A major part of preparation will be to prepare you for after your surgery. Physical and occupational therapists will introduce the muscle-strengthening, ambulation (walking), and range of motion exercises that you will begin performing after your surgery.
What Are The Risks Of Limb Salvage Surgery?
These are the major risks associated with limb salvage: superficial or deep infection at the surgery site; loosening, shifting, or breakage of implants; rapid loss of blood flow or sensation in the affected limb; and severe blood loss and anemia from surgery.
Infection is one of the main risks, as chemotherapy or radiation can weaken the immune system. Tissue may die if a large flap was used to close the wound. This is most likely to happen if the surgery site received radiation prior to having surgery. Amputation is still a possibility.
How Is Limb Salvage Surgery Performed?
These surgeries are always unique depending upon the patient’s situation. The goal is to first remove the tumor, taking as little extra tissue as possible. With bone tumors, Dr. Mehan and Dr. Johnson remove the malignant lesion and a cuff of normal tissue to cure low-grade tumors of bone. To cure high-grade tumors, it’s necessary to remove muscle, bone, and other tissues effect by the tumor, otherwise known as radical resection.
For soft tissue tumor (sarcoma), they will remove the tumor, lymph nodes, or tissues to which cancer has spread, and at least 1 inch of healthy tissue on all sides of the tumor.
How Long Is Recovery After Limb Salvage Surgery?
The recovery period depends upon the bone lesion and its location. You’ll be in the hospital for 5 to 10 days, so we can monitor your repaired limb for sensation and blood flow. We’ll watch for any signs you are developing pneumonia, pulmonary embolism, or deep-vein thrombosis. Wound healing will take about two weeks. If bone healing is necessary, we will have your limb protected and you will need to keep full weight off of it for 6 weeks.
There will be extensive rehabilitation. The amount of bone removed, and the type of reconstruction performed dictate how much you will be able to exercise, but some form of muscle-strengthening, continuous passive motion, and range of motion exercises will begin the day after your surgery and will continue for one year. If you’ve had surgery on a lower extremity, it’s likely you’ll need occupational therapy to learn a new way of walking.