Microvascular applications in limb sparing tumor surgery

New techniques in microvascular tissue transfer make it possible to "add" bone, muscle, and skin to deficient areas and to maintain and restore function. Clearly, a price is paid, but careful evaluation and judicious weighing of the costs and benefits can vastly expand our reconstructive capabilities. Furthermore, as our knowledge of microvascular anatomy expands, new donor sites with particular attributes and less donor site morbidity are constantly being described. The profusion of new procedures and techniques over the last decade is, perhaps, unparalleled in any surgical specialty. Such techniques not only extend our definitions of what is "salvageable," but also refine our conception of what is functionally or cosmetically acceptable. This enables us not only to extend the indications for limb sparing surgery, but also to move beyond merely "salvaging" extremities to reconstructing functional, cosmetically appealing limbs. These are, to be sure, arduous, complicated cases requiring considerable planning and commitment on the part of the surgeon and the patient, but a successful outcome is extremely gratifying to both parties.