Combination of Extracorporeally-irradiated Autograft and Vascularized Bone Graft for Reconstruction of Malignant Musculoskeletal Tumor

Abstract

Background: Reconstruction after wide resection of a malignant musculoskeletal tumor is challenging. We performed biological reconstruction with an extracorporeally-irradiated autograft in combination with a vascularized bone graft. Patients and Methods: Fifteen patients who underwent curative resection of malignant musculoskeletal tumor followed by reconstruction with this method were included. Oncological outcomes, survival of the graft, radiological findings and functional outcomes were reviewed. Results: No local recurrences were detected from the irradiated bones, and 93% of the vascularized bone grafts survived. The mean MSTS score was 24.8 in all cases, 22.9 in the osteoarticular cases, and 27 in the intercalary cases. The intercalary tibia cases showed excellent results with a mean MSTS score of 29.3. Conclusion: This method has the advantage of combining the mechanical quality of an irradiated autograft and biological quality of a vascularized bone graft. The best indication of this method is for intercalary defects of the tibia.Reconstruction of massive bony defects following wide resection of a malignant musculoskeletal tumor is challenging in many cases. Several procedures are available for reconstruction and mega-prosthesis is one of the useful reconstructive tools. However, the relative high rate of complications, limited durability and limited joints may be weak points of the mega-prosthesis. Since this disease is common in the young population, appropriate prostheses are not always available in all cases. While a tailor-made prosthesis may be the solution for such cases, making the prosthesis at the point of operation planning may limit the procedure of wide resection during operation. Wide resection with adequate margin must be performed without any inconvenience during the operation. For these reasons, we performed complete biological reconstruction using extracorporeally-irradiated bone autografts for reconstruction after wide resection, in cases in which no proper prosthesis has been available.Extracorporeal irradiation and re-implantation of a tumor bone was first described by Spira and Lubin in 1968 (1). Since then, several reports have shown excellent local control of the tumor and acceptable to good functional results using irradiated autografts (2-4). However, since the irradiated autografts have no blood supply, serious problems, such as nonunion, infection, fracture and bone absorption, remain. To solve these problems, we utilized the combined use of irradiated autografts with a vascularized bone graft.A vascularized bone graft is a living bone with plenty of blood supply. It is safe and reliable to use vascularized bone graft to reconstruct segmental skeletal defects due to several causes, such as severe trauma (5, 6), resection of malignant tumors or infection. Vascularized bone grafts are expected to provide vascularity and mechanical stability. However, when vascularized bone grafts are used alone, some major issues, such as inadequate adaptation for the recipient site and late fat...

A newly revised pivot knee prosthesis for peri-knee malignant bone destruction tumor management

“…Technological development and improved understanding of the mechanism of carcinoma progression, together with improved staging and classi cation of the carcinoma could make some important impacts on treatment and prognosis. Presently, radically removing the tumor [4], bone grafting [18], and prosthesis arthroplasty [3,19] coupled with preoperative and postoperative chemotherapy [7] have all established advantages, although de ciencies exist in each method. One of the merits of this newly revised pivot knee prosthesis is that it could preserve the knee joint function, which may make the patient live more conveniently and con dently.…”

A New Proximal Femur Reconstruction Technique after Bone Tumor Resection in a Very Small Patient: An Exemplificative Case

“…It has the advantage of a perfect anatomical correspondence, although non-union is common [ 13 ]; moreover, it does not furnish complete information about histology and tumor necrosis after neoadjuvant chemotherapy. Although the hypothetical risk of local recurrence is present, it seems similar to that of other techniques which do not include the reimplantation of the specimen [ 14 ].…”

“…It has the advantage of a perfect anatomical correspondence, although non-union is common [13]; moreover, it does not furnish complete information about histology and tumor necrosis after neoadjuvant chemotherapy. Although the hypothetical risk of local recurrence is present, it seems similar to that of other techniques which do not include the reimplantation of the specimen [14]. (5) Osteoarticular homograft: this is rarely used in isolation for the inferior limb, principally because it collapses under body weight and cannot articulate with the acetabulum, undergoing precocious resorption [15].…”

Strategies for large bone defect reconstruction after trauma, infections or tumour excision: a comprehensive review of the literature

“…Described by Spira and Lubin in 1968 [ 87 ], this technique consists of extracorporeal irradiation with reimplantation of a tumour-bearing bone [ 88 , 89 ]. The first step is to remove the tumour mass with an appropriate margin, along with its surrounding soft tissues [ 4 , 90 ]. Tendons and ligaments are preserved to be reused after irradiation [ 8 , 89 ].…”

“…Tendons and ligaments are preserved to be reused after irradiation [ 8 , 89 ]. Irradiation consists of 60–70 Gy in a single dose [ 88 , 90 ]. A limitation of this procedure is that the irradiated bone fragments have no blood supply and this can lead to infections, fractures, non-union, and bone re-absorption [ 90 , 91 ].…”