Pediatric limb salvage surgery for malignant bone tumors has become the preferred treatment strategy for many patients, offering the potential to preserve both limb function and quality of life without compromising oncologic outcomes. This review highlights the importance of a multidisciplinary team approach involving orthopedic oncologists, pediatric oncologists, radiologists, pathologists, physiotherapists, and psychotherapists. Close collaboration among these specialists is essential to optimize tumor control, functional recovery, and the long-term physical and psychological well-being of children undergoing complex limb-sparing procedures.

The review discusses the two principal reconstructive strategies following tumor resection: biological reconstruction and endoprosthetic reconstruction. Each technique has distinct advantages, limitations, and technical considerations, with the optimal choice depending on factors such as patient age, tumor location, expected skeletal growth, and functional demands. Pediatric limb salvage presents unique challenges, including maintaining limb-length equality, accommodating future growth, and ensuring durable reconstruction that remains functional throughout adulthood. Advances in surgical techniques, biological grafts, and expandable endoprosthetic designs have significantly expanded the range of successful reconstruction options available for young patients.

Overall, the review emphasizes that modern limb salvage can achieve excellent oncologic control while providing favorable functional outcomes and improved quality of life compared with amputation. Continued innovations in reconstructive methods, implant technology, and multidisciplinary care have transformed the management of pediatric malignant bone tumors, enabling individualized treatment plans tailored to each patient's anatomical, developmental, and functional needs. These advances continue to improve long-term survivorship and support successful reintegration into daily life following cancer treatment.