Limb-sparing surgery

This is the most common type of surgery for a primary bone cancer or a soft tissue sarcoma in an arm or leg. It is sometimes called limb-salvage surgery.

For a soft tissue sarcoma, the surgeon removes the tumour and an area of healthy tissue around it. You might need some reconstruction surgery to repair the area.

For a bone cancer the surgeon removes the affected part of the bone and may replace it with either:

• a metal implant (prosthesis)
• bone from another part of the body, or from someone else (bone graft).

If the cancer affects a bone in or near to a joint, the surgeon can often replace the joint with an artificial one.

When you wake up from the operation, you may have a drip (intravenous infusion) going into your arm to replace your body’s fluids. This can be removed as soon as you are drinking enough.

You may have some tubes (drains) to drain fluid from the wound. These are removed when fluid has stopped draining. This should take a few days.

Sometimes, fluid can build up around the wound. The swelling should reduce over a few weeks. Sometimes, a lot of fluid builds up around the wound. This is known as a seroma. It may need to be drained by a doctor or nurse.

Your surgeon may use stitches or clips to close the wound. Sometimes they use dissolvable stitches. If you have stitches or clips that need to be removed, you will be told when and where this will happen.

The nurses will monitor the wound for any signs of infection. Let them know straight away if:

• you feel unwell and have a high temperature
• there is any warmth, swelling and redness around the wound
• there is discharge from the wound.

Pain can usually be controlled effectively with painkillers. They may be given:

• into a vein (intravenously)
• into the space around your spinal cord (epidural)
• into a muscle (intramuscularly)
• as tablets.

To start with, you will probably need a strong painkiller, such as morphine.

You may be given intravenous pain relief through a syringe connected to an electronic pump. The pump can be set to give you a continuous dose of painkiller.

You may also have a handset with a button you can press if you feel sore. This is called patient-controlled analgesia (PCA). It is designed so that you cannot have too much painkiller (an overdose). So it is okay to press it whenever you are uncomfortable.

If you have had surgery to your leg, you may have pain relief using an epidural. This is a fine tube inserted through your back into the area around the spinal cord (the epidural space). A local anaesthetic can be given continuously into this space to numb the nerves that run to the legs.

Let your nurses and doctors know as soon as possible if you are in pain. This will help them give you the combination and dose of painkillers that is right for you.

Your nurses or the physiotherapist will teach you breathing and leg exercises. You can help yourself get better by doing the exercises as often as you need to. They will also encourage you to move around as soon as possible.

Breathing exercises will help prevent you getting a chest infection. Leg exercises will help stop blood clots forming in your legs. Chest infections or blood clots can develop if you are not moving around as much as normal.

To help prevent a blood clot in your leg (a deep vein thrombosis or DVT), you may be given elastic stockings (TED stockings) to wear. You may also be given injections of anti-clotting medicines to help thin your blood.

Limb-salvage surgery is a major operation and rehabilitation can sometimes take a long time. It can often be hard work and may be frustrating at times. This will depend on which limb is affected and how big the operation was.

You will see a physiotherapist soon after your operation. They will encourage and help you to move around as soon as possible.

The physiotherapist will show you exercises to help you keep the most function in the limb. It is important to follow their advice and regularly do the exercises. This will help you recover and reduce the risk of any problems after surgery.

The rehabilitation team will help you get as much independence as possible after the surgery. You may need to make changes to your normal activities. This will depend on the extent of the surgery and how it is affecting you. The occupational therapist will help you with any changes.

Your rehabilitation may take longer if you are also having chemotherapy or radiotherapy.

Sometimes, you will need a brace or support for your limb. If the operation was on your leg, you may be given crutches or another walking aid to use while you are learning to walk again.

At first, your limb will be firmly bandaged, or splinted, to keep it still. This will give the bone graft or implant time to start joining firmly on to the rest of the bone in the limb.

If you have surgery to your hip or knee, you may have to wear a splint or brace for a few months. After surgery to your arm or shoulder, you may need to wear a sling for a few months. Your cancer doctor, specialist nurse or physiotherapist can tell you more about this.

If you have had an operation on your leg or pelvis, you will need help moving around at first. You will use walking aids to help you, such as a frame or elbow crutches. A physiotherapist will teach you how to get in and out of bed. They will also teach you how to safely use any walking aids.

After limb-sparing surgery, you can usually do most of the things you could before treatment. This includes exercise and sports. But there may be some things you cannot do, or you find hard. Your surgeon or physiotherapist can give you more advice about this.