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Isolated limb perfusion, explained for patients and families | CION Cancer Clinics
Isolated limb perfusion is an operation that sends strong chemotherapy through one arm or leg only. Surgeons briefly seal off the limb's blood supply from the rest of your body, pump the drug around the limb with a heart-lung machine, then wash it out. It is used for a small group of melanomas and sarcomas confined to a limb. This page explains how it works, who it does not suit, and what to ask. 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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The short answer
What is isolated limb perfusion, in plain words?
Isolated limb perfusion is an operation that puts very strong chemotherapy into one arm or one leg, and nowhere else. The limb's blood supply is sealed off from the rest of your body for a short time, the drug is pumped around the limb, and then it is washed out before the seal is removed.
Why anyone would do it this way
Some cancers keep coming back in the same limb without spreading to the rest of the body. Removing each lump one by one stops working when there are too many. Chemotherapy through a drip reaches the whole body, so the dose has to stay low enough for your heart, kidneys and bone marrow to cope. Sealing off the limb lets the team use a far stronger dose where the cancer actually is.
Where you may see the name
Doctors often shorten it to ILP. It is most often discussed for melanoma, a skin cancer, that has come back as many small lumps along an arm or leg. It is also used for some soft tissue sarcomas, which are cancers of muscle, fat or other supporting tissue, when the tumour is large and in a limb.
It is a treatment for cancer that is still confined to one limb. It does nothing for cancer elsewhere in the body.How it works
How does the drug stay inside one limb?
The whole procedure is done under general anaesthetic, so you are asleep throughout. In outline, it happens in four stages.
Reaching the main blood vessels
The surgeon makes a cut near the top of the limb, in the groin, the armpit or just above the knee or elbow. The main artery and vein are found, and small tubes are placed inside them.
Sealing the limb off
A tight band is placed around the top of the limb. Together with the tubes, it separates the limb's circulation from the rest of your body for the duration of the treatment.
Circulating the drug
The tubes are connected to a heart-lung machine, which keeps blood moving and supplied with oxygen. The chemotherapy is added, and the limb is gently warmed, which helps the drug work. This usually runs for around an hour or a little longer.
Washing it out
The limb is flushed with fluid until the drug has been removed. The tubes come out, the vessels are repaired, the band is released and the wound is closed.
Not sure whether this applies to you?
Ask an oncologistWhat makes it different
Why not simply give chemotherapy through a drip?
Ordinary chemotherapy and isolated limb perfusion can use related drugs. What changes is where the drug goes and how strong it can be.
A much stronger dose, locally
Because the drug cannot reach your vital organs, the dose inside the limb can be many times higher than your body could safely take through a vein.
Less effect on the rest of you
Effects felt across the whole body, such as a drop in blood counts or hair loss from the head, are usually much milder than with standard chemotherapy.
Mild does not mean none. A small leak is possible, which is why it is watched constantly.The limb takes the strain instead
The treated arm or leg carries the side effects. Redness, swelling, stiffness and, less often, nerve or muscle damage can follow.
Usually settles over
- Several weeks for redness and swelling
- Longer for stiffness or numbness
A local treatment only
It treats the limb and nothing beyond it. If scans show the cancer has reached the lungs, liver or other organs, a treatment that works across the whole body is usually discussed instead.
On your letter or report
What do the words in the surgeon's letter mean?
- ILP
- Isolated limb perfusion. The open operation described on this page, using a heart-lung machine.
- ILI
- Isolated limb infusion. A less invasive relative, where thin tubes are passed in through the skin and no heart-lung machine is used.
- Melphalan
- The chemotherapy drug most often used inside the limb.
- TNF
- Tumour necrosis factor. A protein sometimes added to melphalan, mainly for large sarcomas, that damages the blood supply of the tumour.
- In-transit metastases
- Melanoma that has come back as lumps in the skin or just under it, between the original spot and the nearest lymph glands.
- Leak monitoring
- A tiny amount of a radioactive tracer is added to the limb circuit, and a detector over the chest checks that none is escaping into the body.
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Did you know
Isolated limb perfusion was first described more than sixty years ago, yet it is still carried out at relatively few specialist centres worldwide. If it has been suggested, it is reasonable to ask how often the team performs it.
Being straight with you
Who is it not suitable for?
Isolated limb perfusion suits only a small group of people. Your treating team weighs the type of cancer, where it sits and your general health before raising it. The decision to go ahead belongs to them and to you together.
When the cancer has spread beyond the limb
If scans show cancer in the lungs, liver, brain or other distant places, treating the limb alone does not address the main problem. The team will usually discuss whole-body treatments such as immunotherapy or targeted therapy first.
When a long anaesthetic is too risky
It is a major operation lasting several hours. Serious heart or lung disease, poorly controlled diabetes or severe problems with the blood vessels in the legs may make it unsafe. Isolated limb infusion is sometimes considered in this situation.
What this page cannot tell you
It cannot tell you whether the treatment will work on your cancer, or whether it is right for you. Those answers depend on your scans, your biopsy and a surgeon who has examined you.
Tumours very close to the hip or shoulder can be hard to seal off. Ask whether the position of yours is a problem.Commonly believed
What do families often get wrong about it?
"It is the same as chemotherapy, just given in the arm."
A drip in the arm sends the drug around the whole body. Isolated limb perfusion keeps the drug inside the limb by sealing it off, which is why it needs an operation, a heart-lung machine and a general anaesthetic.
"If they are doing this, the limb will be amputated anyway."
One of its main purposes is to keep the limb. It does not always succeed, and amputation is sometimes still discussed later, but the procedure itself removes nothing.
"Once the limb is treated, the cancer is finished."
Lumps can shrink or disappear and still come back, either in the same limb or elsewhere. Regular check-ups and scans continue afterwards, often for years.
"Any big hospital can do it."
It needs a surgical team, a perfusionist to run the machine and leak monitoring working together. Few centres in India offer it, so ask directly rather than assuming.
Questions we are asked
Common questions about isolated limb perfusion
Is isolated limb perfusion surgery or chemotherapy?
It is both. A surgical oncologist performs the operation to reach the blood vessels and seal off the limb, and chemotherapy is the treatment that actually acts on the cancer. That is why you may meet a surgeon, an anaesthetist and a medical oncologist before it is planned, and why the decision is usually made at a tumour board.
Will I be awake while it is done?
No. It is done under general anaesthetic, so you are fully asleep and feel nothing during the procedure. You will wake up in a recovery area with the limb bandaged and raised. Pain relief is given from the start, and the anaesthetist will explain what to expect before the day.
Will my hair fall out?
Hair loss from the head is uncommon, because very little of the drug reaches the rest of the body. The hair on the treated arm or leg often falls out for a while, and usually grows back. Your nails on that limb may also change or lift before new ones grow.
How long will I be in hospital?
Usually around a week, sometimes longer. The team watches the limb closely in the first days for swelling, skin changes and blood flow, and checks your blood tests. The length of stay depends on how the limb reacts, so plan for family support at home for several weeks after discharge.
Can it be repeated if the cancer comes back?
Sometimes, if the cancer returns in the same limb and has not spread elsewhere. A repeat perfusion is technically harder because of scarring around the blood vessels. Isolated limb infusion, which is less invasive, is often easier to repeat. Your team will weigh this against other options at that point.
Does it treat cancer that has spread to other organs?
No. It treats only the arm or leg that is sealed off. Cancer in the lungs, liver or elsewhere needs treatment that works across the whole body. This is why you will have scans before it is offered, to check that the cancer really is confined to the limb.
What side effects should I expect in the limb?
Most people have redness, warmth and swelling of the treated limb for some weeks, rather like a bad sunburn. Stiffness, blistering, numbness or muscle pain can also happen. Rarely, the swelling becomes severe enough to need an urgent operation to relieve pressure. The team checks for this closely in the first days.
Is it available in Hyderabad, and will schemes cover it?
Few centres in India perform it, so ask any centre directly whether it offers the procedure and how often. Coverage under Aarogyasri, CGHS, ECHS, EHS or cashless insurance depends on your scheme and the approved treatment plan. Call the helpline and we can help you understand your options and cover.
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Sources
- National Cancer Institute — Melanoma Treatment (PDQ) - Patient Version
- National Cancer Institute — Adult Soft Tissue Sarcoma Treatment (PDQ) - Patient Version
- Cancer Research UK — Treatment for melanoma
- NICE — Melanoma: assessment and management (NG14)
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 DifferenceHow the less invasive version comparesWhich Cancers It Is Used ForMelanoma, sarcoma and the rarer casesWhat Happens During the ProcedureThe day of the operation, step by stepSide Effects in the Treated LimbWhat the limb goes through afterwardsDeciding on Cancer SurgeryQuestions to ask before you agree to an operation
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Has a limb procedure been suggested?
Tell us what has been found so far. A surgical oncologist will go through your reports with you and explain the options your team is weighing. One helpline serves every CION centre.