Limb-preserving surgery is the main method and the main direction of development in the treatment of malignant bone and soft tissue tumors of the extremities. Limb preservation surgery includes extensive resection of tumor, reconstruction of bone and soft tissue defects, and functional reconstruction of limbs. The current indications for limb-preserving surgery for malignant bone tumors are: ① Enneking stage IA, IB, IIA and stage IIB tumors with good response to chemotherapy in the extremities, pelvis and shoulder. ②Malignant bone tumors without major neurovascular involvement, pathological fractures and diffuse skin infiltration. (③) Those with good general condition and local soft tissue conditions, who can reach the surgical border of radical or extensive resection, and who are expected to have a local recurrence rate no higher than amputation. ④Good reconstructive techniques and reconstructive conditions are available, and the function of the preserved limb is expected to be better than that of the prosthesis installed after amputation. ⑤ Those with no metastases or single metastases that can be cured by wide excision after systemic chemotherapy. ⑥Patients and family members who request limb preservation and are financially qualified and can actively cooperate with the treatment. Contraindications to limb preservation therapy include: ① Extensive tumor, unable to achieve extensive or marginal (except chemotherapy-sensitive patients) resection. (2) The tumor has advanced and extensive metastases and is expected to survive for less than 6 months. ③Poor local skin, soft tissue and blood supply due to radiotherapy or repeated surgery, which may lead to difficult closure of incision or skin and soft tissue necrosis after surgery. ④There is still active infection in the tumor or other parts of the body. ⑤ Those who have poor general condition and can hardly tolerate larger surgery. However, with the continuous improvement and development of treatment methods, the scope of indications for limb preservation surgery has been expanding. It has become the preferred treatment option for highly malignant bone tumors of the limb. For example, Ennecking surgical staging of stage IIA is traditionally considered the best indication for limb-sparing surgery, but chemotherapy-sensitive stage IIB tumors are now largely amenable to limb-sparing treatment. Pathologic fracture is considered a relative contraindication to limb-preserving therapy. Malawer et al. followed 82 patients with malignant bone tumors treated with limb-preserving therapy (76 of whom were stage IIB and III patients), with a 5-year survival rate of 83%, a 10-year survival rate of 67%, and a local recurrence rate of 6%. The appropriateness of limb-sparing surgery for malignant bone tumors complicated by pathological fractures has been controversial. The incidence of pathologic fracture at diagnosis or during preoperative treatment is about 5-10%. Jaffe et al. believe that patients who have developed pathologic fracture should not undergo limb-sparing surgery even if the pathologic fracture heals after preoperative adjuvant chemotherapy because the pathologic fracture of the primary tumor can cause hematoma, which can then infiltrate into the surrounding tissues and contaminate them, including neurovascular bundles, adjacent joints, and so on. However, Malawer et al. considered pathologic fracture as a relative contraindication to limb-sparing surgery, and Turcotte et al. considered pathologic fracture as one of the important factors affecting patient prognosis, but Grimer et al. treated 40 patients with osteosarcoma with pathologic fracture in long bones, and all cases were treated with preoperative adjuvant chemotherapy, of which 27 were treated with limb-sparing therapy. Scully SP et al. concluded, using multicenter clinical data, that patients with pathological fractures have higher local recurrence rates and mortality than those without fractures, and thus, when selecting cases with pathological fractures for limb-preserving surgery, factors such as whether the malignant bone tumor is sensitive to chemotherapy and whether the fracture can heal should be considered to achieve better outcomes. Neurovascular involvement is a contraindication for limb-sparing surgery, but better results have been obtained after reconstruction of the involved vessels. nishinari applied autologous saphenous vein or artificial vessels (polytetrafluoroethylene or polyester fiber) to reconstruct the tumor-invaded vessels in 20 patients with vascular involvement, and the local recurrence rate was 20%. Revascularization can be a means of limb-preserving treatment for malignant bone tumors, where arterial reconstruction, regardless of the alternative used, has low complications, whereas venous reconstruction requires autologous grafts because of the high postoperative complications of artificial alternatives. If the peroneal nerve is involved, surgery will cause damage to it and there will be postoperative sensory-motor deficits in the lower leg, but the limb will retain most of its function. healey considers the common peroneal nerve to be a contraindication to limb-sparing surgery for tumors of the upper tibia. However, if the sciatic or median nerve is involved, then the nerve injury will result in functional disability of the limb, so limb-sparing surgery should not be performed.