Goals:
(1) complete removal of the tumor
(2) good functional status
(3) adequate soft tissue coverage
Indications to perform limb-sparing surgery - all of the following:
(1) no major neurovascular involvement
(2) wide resection of the affected bone, with normal muscle cuff in all directions
(3) en bloc removal of all previous biopsy sites and potentially contaminated tissue
(4) resection of bone 3-4 cm beyond abnormal uptake seen on imaging studies
(5) resection of the adjacent joint and capsule (unless in the diaphysis)
(6) adequate motor reconstruction using regional muscle transfers
(7) adequate soft tissue coverage
Contraindications:
(1) extension of tumor beyond accurately determined limits
(a) simultaneous medial, lateral and/or soft tissue extension
(b) pathologic fractures with potential tumor spread into hematoma
(2) major neurovascular involvement
(3) involvement in soft tissue tendons or muscles required for functional use, or insufficient muscle to reconstruct a functional extremity
(4) local infection
