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. 2015:2015:861575.
doi: 10.1155/2015/861575. Epub 2015 Feb 16.

Intercalary reconstruction after wide resection of malignant bone tumors of the lower extremity using a composite graft with a devitalized autograft and a vascularized fibula

Koichi Ogura  1 , Shimpei Miyamoto  2 , Minoru Sakuraba  2 , Tomohiro Fujiwara  1 , Hirokazu Chuman  1 , Akira Kawai  1
Affiliations

Intercalary reconstruction after wide resection of malignant bone tumors of the lower extremity using a composite graft with a devitalized autograft and a vascularized fibula

Koichi Ogura et al. Sarcoma. 2015.

Abstract

Introduction. Although several intercalary reconstructions after resection of a lower extremity malignant bone tumor are reported, there are no optimal methods which can provide a long-term reconstruction with fewest complications. We present the outcome of reconstruction using a devitalized autograft and a vascularized fibula graft composite. Materials and Methods. We conducted a retrospective review of 11 patients (7 males, 4 females; median age 27 years) undergoing reconstruction using a devitalized autograft (pasteurization (n = 6), deep freezing (n = 5)) and a vascularized fibula graft composite for lower extremity malignant bone tumors (femur (n = 10), tibia (n = 1)). Results. The mean period required for callus formation and bone union was 4.4 months and 9.9 months, respectively. Four postoperative complications occurred in 3 patients: 2 infections (1 pasteurized autograft, 1 frozen autograft) and 1 fracture and 1 implant failure (both in pasteurized autografts). Graft removal was required in 2 patients with infections. The mean MSTS score was 81% at last follow-up. Conclusions. Although some complications were noted in early cases involving a pasteurized autograft, our novel method involving a combination of a frozen autograft with a vascularized fibula graft and rigid fixation with a locking plate may offer better outcomes than previously reported allografts or devitalized autografts.

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Figures

Figure 1
Figure 1
Illustration showing reconstruction of a femur diaphysis using a composite graft with a devitalized autograft and a vascularized fibula graft.
Figure 2
Figure 2
A plain radiograph of the left distal femur demonstrates an osteolytic lesion with destruction of the cortex and intratumoral ossification (a). Coronal MR images demonstrate a large extraosseous mass with destruction of the cortex (b). Reduction in size of the tumor was noted after preoperative chemotherapy (c).
Figure 3
Figure 3
The composite graft was rigidly fixed to the host bone with a locking plate and screws ((a) operative photograph, (b) postoperative plain radiograph). A plain radiograph 9 months after surgery. Bone union was achieved (c).
Figure 4
Figure 4
A CT scan at 39 months after surgery. Bridging bone formation from the hypertrophic inlaid fibula to the frozen autograft is evident.
See this image and copyright information in PMC

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