Prehabilitation for Limb Salvage Surgery: A Practical and Evidence-based Guide

Surgical procedures carry inherent risks that can result in significant complications. Prehabilitation, a multidisciplinary preoperative strategy, aims to prepare patients for surgery and enhance postoperative recovery by optimizing various aspects of their health. This comprehensive review examines the role of prehabilitation in limb salvage surgery (LSS), focusing on vascular health, muscle mass, range of motion, psychological, and lifestyle optimization. The synthesis evaluated current literature on prehabilitation strategies in LSS, highlighting key areas for preoperative optimization, and offers a practical, evidence-based guide for prehabilitation in LSS. This guide includes discussions about shared decision-making, nutritional and metabolic considerations, and the management of comorbid conditions, including limb-, psychological-, and lifestyle-based optimizations. These strategies reduce frailty and improve surgical outcomes, which is particularly relevant for LSS patients, given their frequent predisposition to increased frailty. Despite this, standardized prehabilitative approaches in LSS remain underexplored. Comprehensive prehabilitation, tailored to individual patient needs, is crucial for optimizing outcomes in LSS. Further research is necessary to establish standardized protocols and broaden the application of prehabilitation in this specialized area of surgery.