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What happens during isolated limb perfusion | CION Cancer Clinics
Isolated limb perfusion is done under general anaesthetic. The surgeon seals off the blood flow of one arm or leg, connects it to a pump, and circulates warmed, high-strength chemotherapy through that limb alone. The drug is then washed out and the circulation restored. This page walks through each stage, who is in the room, and who the operation does not suit. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
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Medically reviewed by Dr. Muralidhar MuddusettyConsultant Surgical Oncologist · MBBS (AIIMS), MS (Surgery, AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh) · last reviewed September 2026, next review due September 2027
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On this page
- What happens during isolated limb perfusion?
- What happens in the operating theatre, step by step?
- Who is in the room with you, and what do they do?
- How is the day different with isolated limb infusion?
- What do the words on your consent form mean?
- What do families often believe about this operation?
- Who does it not suit, and what can this page not tell you?
- Common questions about the isolated limb perfusion procedure
The short answer
What happens during isolated limb perfusion?
During isolated limb perfusion you are fully asleep while the surgeon separates the blood flow of one arm or leg from the rest of your body. A pump then circulates warmed, high-strength chemotherapy through that limb alone, before the drug is washed out and the normal circulation is restored.
Why the limb is sealed off
Chemotherapy given into a vein travels everywhere, so the dose is limited by what your whole body can take. With the limb sealed off, the drug can be far stronger inside the arm or leg, while very little reaches your heart, kidneys or bone marrow.
Which cancers it is used for
It is used mainly for melanoma or sarcoma that keeps coming back in one arm or leg, often as many small lumps in or just under the skin, where removing each one is no longer practical. It treats the limb only. It does nothing for cancer elsewhere in the body.
In the operating theatre
What happens in the operating theatre, step by step?
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The anaesthetic
You are given a general anaesthetic, so you are asleep and feel nothing. Monitoring lines are placed and the limb is kept warm.
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Reaching the main blood vessels
The surgeon makes a cut near the top of the limb, in the groin for a leg or near the armpit for an arm, and frees the main artery and vein. Nearby lymph nodes, the small glands that filter fluid from the limb, are sometimes removed at the same time.
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Connecting the pump
A blood thinner is given so blood does not clot in the tubing. Tubes go into the artery and vein and are joined to a pump with an oxygen unit, similar to the machine used in heart surgery.
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Sealing off the limb
A tight band called a tourniquet is fastened around the top of the limb. With the tubes, it keeps the limb's blood apart from the rest of your circulation.
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Checking for leaks
A tiny amount of radioactive tracer is added to the limb circuit. A probe over your heart watches for any tracer escaping into the body. If a leak shows, the team adjusts the flow or stops early.
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Warming the limb and giving the drug
Once the limb is warm and the circuit is steady, the chemotherapy, most often melphalan, is added. It circulates for a fixed time the team has planned.
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Washing out and closing
The limb is rinsed with fluid to clear the drug. The tourniquet and tubes come off, the blood vessels are repaired and the wound is stitched.
Not sure whether this applies to you?
Ask an oncologistThe team
Who is in the room with you, and what do they do?
More people than for most operations, because the pump and the leak check each need their own expert.
The surgical team
The surgical oncologist opens the blood vessels, places the tubes and repairs everything at the end.
The anaesthetist
Keeps you asleep and manages blood pressure, fluids and heart rate. A steady body matters here, because the leak check depends on it.
The perfusionist
The specialist who runs the pump, the same role as in heart surgery. They control the flow, the warmth of the limb and the oxygen in its blood.
The nuclear medicine team
They prepare the tracer and read the probe over your heart throughout, so a leak is spotted within moments.
Worth asking your centre
- How often the team performs it
- How a leak is handled
- Whether an intensive care bed is booked
Side by side
How is the day different with isolated limb infusion?
Isolated limb perfusion
Isolated limb infusion
Perfusion reaches the blood vessels through an open cut at the top of the limb
Infusion uses thin tubes passed in through the groin by a radiologist
A pump with an oxygen unit keeps the limb's blood moving
No oxygen unit; the drug is pushed round the limb by syringe
The drug usually circulates for longer
The drug usually circulates for a shorter time
A longer operation and a larger wound to heal
Usually shorter, with a smaller wound, and easier to repeat
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On your consent form
What do the words on your consent form mean?
- Perfusion
- Pumping fluid through tissue by way of its own blood vessels. Here, it means pumping drug-carrying blood through the limb.
- Tourniquet
- The tight band around the top of the limb that stops blood passing in or out except through the pump tubes.
- Melphalan
- The chemotherapy drug most often used. Your team works out the dose from the size of your limb.
- Hyperthermia
- Warming the limb a little above normal body temperature, which helps the drug act on the cancer.
- Fasciotomy
- Cuts through the tough sheet around the muscles, made if swelling afterwards starts to squeeze them.
Commonly believed
What do families often believe about this operation?
"The chemotherapy will make all my hair fall out, like it did for my relative."
Very little of the drug reaches the rest of your body, so hair loss on the head and whole-body sickness are much less common than with chemotherapy through a vein. Hair on the treated limb itself may fall out for a while.
"They will cut into the limb and take the cancer out."
The cut is made to reach the blood vessels, not the tumours. The lumps are treated by the drug and usually shrink over the following weeks and months, not on the day. Some may later need removing separately.
"If there is a leak, the operation has failed."
A small leak is exactly what the monitoring is there to catch. The team can adjust the flow, or stop the drug and wash the limb early. Your blood counts are then watched more closely.
"Once it is done, the cancer cannot come back in that limb."
It can. Many people respond well, but new lumps may appear later. Sometimes the treatment can be repeated. Your follow-up visits exist to spot this early.
Being straight with you
Who does it not suit, and what can this page not tell you?
Isolated limb perfusion is a large operation. The decision to offer it belongs to your team and to you.
Who it usually does not suit
It is rarely offered when the cancer has already spread widely inside the body, because it treats only the limb. It may not be possible if the main blood vessels of the limb are badly narrowed, if the tumour sits so high that a tourniquet cannot seal it off, or if your heart and lungs would struggle with a long anaesthetic. For some people, isolated limb infusion, surgery, radiotherapy or medicines through a vein fit better.
What this page cannot tell you
It cannot tell you whether this operation is right for you, how your own limb will respond, or how long your operation will take. Those depend on your cancer, your blood vessels and your general health. Few centres in India perform it, so ask the team how often they do it and what they do if a leak is found.
Bring your scan reports and a list of every medicine you take, including blood thinners, to the consultation. Do not stop any of them on your own.Questions we are asked
Common questions about the isolated limb perfusion procedure
Will I be awake during isolated limb perfusion?
No. It is done under general anaesthetic, so you are fully asleep throughout and will not remember it. Some centres also place a thin tube in your back for pain relief afterwards. The anaesthetist will explain their plan and answer your questions when they see you before the operation.
How long does the operation take?
Several hours, longer than the drug time alone, because connecting the pump, checking for leaks and repairing the blood vessels all take care. Your family should expect a long wait. Ask the team for their usual timing, and who will update your family when it is over.
Will I need intensive care afterwards?
Many centres move patients to intensive care or a high-dependency bed for the first night, so the limb, kidneys and heart can be watched closely. Others use a surgical ward with close nursing. Neither is a sign that something went wrong. Ask where you will wake up.
Is the drug the same as chemotherapy through a drip?
The drug may be the same, most often melphalan, but the way it is given is very different. It stays inside the sealed limb at a strength your body could not take through a vein, and it is washed out before the circulation is reconnected. Whole-body effects are usually much milder.
Why is the limb warmed during the procedure?
Warming the limb a little above normal body temperature helps the drug act on the cancer cells and spread evenly through the tissue. Small probes measure the temperature throughout. It is kept carefully controlled, because too much heat can add to the limb's reaction afterwards.
Will they remove lymph nodes from my groin or armpit too?
Sometimes. Because the surgeon is already working near them, nodes may be removed at the same operation if scans or earlier tests suggest cancer there. This is decided beforehand and should be written on your consent form. If you are unsure whether it is planned, ask before the day.
Can both legs be treated at the same time?
Usually not. Each limb has its own blood supply and needs its own circuit, and treating one at a time keeps the operation safer and the leak check reliable. If both limbs are affected, your team will discuss the order and whether another treatment fits better.
Does CION perform isolated limb perfusion?
Only a small number of centres in India perform it, and that changes over time. CION's surgical oncologists can review your reports, explain whether limb treatment is worth discussing, and help you reach a centre that does it. Whichever centre you consider, ask how often its team performs the procedure.
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MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
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Dr. Vinay Mamidala
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Sources
- National Cancer Institute — Melanoma Treatment (PDQ) - Patient Version
- National Cancer Institute — Soft Tissue Sarcoma Treatment (PDQ) - Patient Version
- Cancer Research UK — Melanoma
- Cancer.Net — Melanoma: Types of Treatment
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Perfusion vs Infusion: The DifferenceThe less invasive version, and when it is chosenSide Effects in the Treated LimbWhat the limb goes through in the days afterwardsRecovery and Limb Function AfterwardsHow long it takes to use the limb againAnaesthesia for Cancer SurgeryWhat the general anaesthetic involvesIsolated Limb Perfusion and InfusionThe full guide to limb perfusion and infusion
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