(iii) The principles of surgical resection and reconstruction of bone tumours

The management of bone tumours has made vast strides in the last few decades. The advent of better imaging modalities, more effective chemotherapy, improved radiotherapy techniques, a better understanding of anatomy with continuous refinement in surgical techniques and advances in prosthesis design and materials have all played a part in increasing the incidence of limb salvage surgery. From an era where amputation was the only option, the current day function preserving resections and complex reconstructions have been a major advance.This article highlights the concepts of surgical margins in oncology, discusses the principles governing safe surgical resection in malignant bone tumours and describes the various reconstruction options available in order to restore structural and skeletal stability after resection of large bone segments. The rationale of choice of a particular resection modality, the unique challenges of reconstruction in skeletally immature individuals and the impact of adjuvant modalities like chemotherapy and radiotherapy on surgical outcomes are also discussed.