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. 2021 Aug 31;22(1):750.
doi: 10.1186/s12891-021-04629-3.

Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

Alexander Klein  1 , Yasmin Bakhshai  2 , Falk Roeder  3 , Christof Birkenmaier  2 , Andrea Baur-Melnyk  4 , Hans Roland Dürr  5
Affiliations

Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

Alexander Klein et al. BMC Musculoskelet Disord. .

Abstract

Background: Reconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of a vital autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation.

Methods: Twenty-one patients with 22 reconstructions were included. In all cases, the bone tumor was resected with wide margins and in 21 of them irradiated with 300 Gy. In the first case, thermal sterilization in an autoclave was used. The autograft was orthotopically replanted and stabilized with plates and screws. Fifteen patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a locally pedicled fibular interposition.

Results: the most common diagnosis was a Ewing sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months (16-154 months). For our statistical analysis, the one case with autoclave sterilization and 3 patients with tumors in small bones were excluded. During follow-up of 18 cases, 55.6% of patients underwent an average of 1.56 revision surgeries. Complete bony integration of the irradiated autografts was achieved in 88.9% of cases after 13.6 months on average. In those cases with successful reintegration, the autograft was shorter (n.s.). Microvascular anastomosis in vascularized fibular strut grafts did not significantly influence the rate of pseudarthrosis.

Conclusions: the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors that allow for joint preservation. However, these patients should be ready to accept longer treatment periods.

Keywords: Autograft; Bone reconstruction; Bone tumor; Fibular graft; Irradiated bone; Pseudarthrosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Technique of tumor resection and biological reconstruction with irradiated diaphyseal tibia autograft. a: Resection of the tumor in the tibial diaphysis; b: Transposition of the ipsilateral fibula into the tibial defect; c: Interposition of the irradiated segment covering the fibular transplant prior to osteosynthesis. The plate osteosynthesis (Limited Contact Dynamic Compression Plate) was performed as next step
Fig. 2
Fig. 2
Osteosarcoma of the distal femur in an 11-year-old boy; a + b: Preoperative a.p. and lateral view; c + d: Bony integration using a non-vascularized fibular augmentation 4 years after surgery
See this image and copyright information in PMC

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