Combined use of free vascularised bone graft and extracorporeally-irradiated autograft for the reconstruction of massive bone defects after resection of malignant tumour

Abstract

We review eight patients who underwent curative resection for malignant musculoskeletal tumour followed by reconstruction with vascularised bone graft in combination with extracorporeally-irradiated autograft. This method consists of (1) wide en-bloc resection of the tumour; (2) curettage of tumour from the resected bone; (3) extracorporeal irradiation with 60 to 70 Gy as a bolus single dose; (4) vascularised bone grafting from the fibula (six cases) or scapula (two cases); (5) re-implantation of the irradiated bone into the recipient and fixation with plates and screws. Five cases were located in the tibial shaft and one each in the ulnar shaft, distal femur and acetabulum. Radiological and functional outcomes were excellent in four patients who were reconstructed with vascularised fibula and irradiated intercalary tibial bone graft. Two patients with irradiated osteochondral graft showed osteoarthritic change in the long term. No local recurrences arising from the irradiated bones were detected. Combination of a vascularised and an extracorporeally-irradiated bone graft is a useful reconstructive tool for massive bone defects arising from resection of malignant musculoskeletal tumour. This approach has the advantage of combining the biological properties provided by the vascularised bone graft with the mechanical endurance of the irradiated bone autograft. The method is best indicated for intercalary defects of the tibia.