Complex Biological Reconstruction after Wide Excision of Osteogenic Sarcoma in Lower Extremities

Abstract

Wide margin resection of extremity tumor sometimes leaves a huge soft tissue and bony defects in limb salvage surgery. Adequate management of these defects is an absolute requirement when aiming for functional limb. Multidisciplinary management in such cases is an answer when complex biologic reconstruction is desired. We aim to present cases of osteogenic sarcoma of lower extremity requiring combined surgical approach to achieve effective musculoskeletal reconstruction. Patients and Methods. From 2006 to 2010 ten patients were operated on for osteogenic sarcoma of lower extremity requiring complex musculoskeletal reconstruction. Results. Six patients had pathology around knee joint, whereas one each with mid tibia, mid femur, proximal femur, and heel bone. Locking compression plate was used in 7 patients including six with periarticular disease. Eight out of ten patients underwent biologic reconstruction using autograft; endoprosthetic reconstruction and hindquarter amputation were done in the remaining two patients. Vascularized fibula was done in five patients, sural artery flap which was primarily done in three patients, spare part fillet flap, free iliac crest flap, and Gastrocnemius flap was done in one patient each. Secondary hemorrhage, infection, nonunion, wound dehiscence, and flap failure were notable complications in four patients. The Average Musculoskeletal Tumor Society score was 89%. Conclusion. Combined surgical approach results in cosmetically acceptable and functional limb.

Diagnoses, treatment, and oncologic outcomes in patients with calcaneal malignances: Case series, systematic literature review, and pooled cohort analysis

“…A modified Capanna technique has been reported in two patients, in which pedicled or free fibular grafts were inserted into whole calcaneal allografts and affixed to the talus, with reported radiographic union by 6–9 months and full weight‐bearing at 7 months 33 . A “folded” pedicled fibular graft technique, which obviated the need for structural allograft, 6 and vascularized free iliac crest graft after osteosarcoma resection, have also been described 53 . There have been two reports of post‐calcanectomy reconstruction with custom metal prostheses for tumor patients.…”

“…Exclusion criteria for reviewed studies were (1) language other than English; (2) tumor location other than calcaneus; (3) lesions metastatic to the calcaneus; (4) failure to report age, diagnosis, treatment modality, oncologic outcome, and follow‐up duration for each individual patient. In total, we identified 53 such studies for inclusion in this review (Appendix) 1,5,6,11‐60 . Variables of interest included age, diagnosis, sex, histologic grade, tumor size/volume, surgical treatment group (sub‐classified as amputation, wide resection [ie, partial or total calcanectomy], intra‐lesional/marginal procedure, or nonoperative management), treatment with chemotherapy and/or radiation, recurrence and time to recurrence, metastasis and time to metastasis, death and time to death, and length of follow‐up.…”

“…33 A "folded" pedicled fibular graft technique, which obviated the need for structural allograft, 6 and vascularized free iliac crest graft after osteosarcoma resection, have also been described. 53 There have been two reports of post-calcanectomy reconstruction with custom metal prostheses for tumor patients. Chou and prone to error in certain cases; we opted to include a case of melanoma, as it was described in the published report as a "primary" bone tumor, 32 without other evident sites of disease, and treated as such.…”

Free Vascularized Fibular Graft Transfer in the Reconstruction of Defects for Premalignant and Malignant Musculoskeletal Conditions of the Femur in a Tertiary Care Setting in Pakistan: A Series of Six Cases

“…Despite this, they considered FVFG to be an acceptable option for reconstruction [13]. Abbas, et al in 2013 utilized a FVFG for four cases of osteosarcoma of the femur and tibia, out of which one case had a delayed union [14]. …”