Intercalary defects reconstruction of the femur and tibia after primary malignant bone tumour resection. A series of 13 cases

Brunet, O.; Anract, Philippe; Bouabid, Salim; Babinet, Antoine; Dumaine, Valérie; Toméno, B; Biau, David

doi:10.1016/j.otsr.2011.03.021

Cited by 31 publications

(16 citation statements)

References 35 publications

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“…26 Fracture rates for fibula flap reconstruction in combination with a massive allograft have been reported at up to 29 percent; nonunion rates are reported to range from 9 percent to 31 percent, infection rates are up to 23 percent, and in one series, flap loss was reported as 6.5 percent. 12,[27][28][29] Our functional results and complication rates compare favorably with the rates quoted in the literature.…”

Section: Plastic and Reconstructive Surgery • August 2015supporting

confidence: 83%

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

Weichman

Dec

Morris

et al. 2015

Plastic and Reconstructive Surgery

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Section: Plastic and Reconstructive Surgery • August 2015supporting

confidence: 83%

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

Weichman

Dec

Morris

et al. 2015

Plastic and Reconstructive Surgery

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“…A relatively small proportion of bone tumours (< 10%) are located in the meta-diaphyseal region, allowing for segmental resection with preservation of the adjacent joint. [1][2][3][4][5][6][7] Reconstruction of these defects may be undertaken with an endoprosthesis, an allograft, an autograft or a combination of these modalities. Intercalary allografts may be used for smaller defects.…”

Section: In 35 Patients (47%) At Least One Complication Arose With Amentioning

confidence: 99%

The vascularised fibular graft for limb salvage after bone tumour surgery

Hilven

Bayliss

Cosker

et al. 2015

The Bone & Joint Journal

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Vascularised fibular grafts (VFGs ) are a valuable surgical technique in limb salvage after resection of a tumour. The primary objective of this multicentre study was to assess the risk factors for failure and complications for using a VFG after resection of a tumour. The study involved 74 consecutive patients (45 men and 29 women with mean age of 23 years (1 to 64) from four tertiary centres for orthopaedic oncology who underwent reconstruction using a VFG after resection of a tumour between 1996 and 2011. There were 52 primary and 22 secondary reconstructions. The mean follow-up was 77 months (10 to 195). In all, 69 patients (93%) had successful limb salvage; all of these united and 65 (88%) showed hypertrophy of the graft. The mean time to union differed between those involving the upper (28 weeks; 12 to 96) and lower limbs (44 weeks; 12 to 250). Fracture occurred in 11 (15%), and nonunion in 14 (19%) patients. In 35 patients (47%) at least one complication arose, with a greater proportion in lower limb reconstructions, non-bridging osteosynthesis, and in children. These complications resulted in revision surgery in 26 patients (35%). VFG is a successful and durable technique for reconstruction of a defect in bone after resection of a tumour, but is accompanied by a significant risk of complications, that often require revision surgery. Union was not markedly influenced by the need for chemo- or radiotherapy, but should not be expected during chemotherapy. Therefore, restricted weight-bearing within this period is advocated.

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“…11 We were surprised, though, by the strength disparity between fixated femurs and controls because IM nailing has been successfully used in clinical practice for reconstruction of segmental femur defects more extensive than those in our osteotomy. 27,28 Unfortunately, previous biomechanical studies of lytic lesions, as well as traumatic femur fractures, lack either control data on intact femurs or data on the residual weakness of fixated femurs compared with intact femurs. 13,15,20,21,29,30 Accordingly, we were unable to identify a comparison study reporting how much weaker a successfully fixated femur is expected to be than an intact femur in these settings.…”

Section: Discussionmentioning

confidence: 99%

Association of the Anterolateral Thigh Osteomyocutaneous Flap With Femur Structural Integrity and Assessment of Prophylactic Fixation

Worley

Patterson

Graboyes

et al. 2018

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE The chimeric anterolateral thigh osteomyocutaneous (ALTO) free flap is a recently described microvascular option for head and neck osseous defects associated with complex soft-tissue requirements. To date, the association of ALTO flap harvest with femur structural integrity and the need for routine prophylactic fixation following harvest has been incompletely described. OBJECTIVE To investigate the association of ALTO flap harvest, with and without prophylactic fixation, on femur structural integrity as measured by 4-point bend and torsional biomechanical testing. DESIGN AND SETTING At a research laboratory, 24 synthetic fourth-generation composite femurs with validated biomechanical properties underwent 10-cm-long, 30% circumferential osteotomies at the proximal middle third of the femur; 6 femurs served as controls. Osteotomized femurs with and without fixation underwent torsional and 4-point bend biomechanical testing. Femur fixation consisted of intramedullary nail and distal interlock screw placement. MAIN OUTCOMES AND MEASURES Force and torque to fracture (expressed in kilonewtons [kN] and Newton meters [N·m], respectively) were compared between controls, osteotomized femurs without fixation, and osteotomized femurs with fixation. Additional outcome measures included femur stiffness and fracture patterns. RESULTS On posterior to anterior (PA) 4-point bend testing, force to fracture of osteotomized femurs was 22% of controls (mean difference, 8.3 kN; 95% CI, 6.6–10.0 kN). On torsional testing the torque to fracture of osteotomized femurs was 12% of controls (mean difference, 351.1 N·m; 95% CI, 307.1–395.1 N·m). Following fixation there was a 67% improvement in PA force to fracture and a 37% improvement in torque to fracture. However, osteotomized femurs with fixation continued to have a reduced PA force to fracture at 37% of controls (mean difference, 6.8 kN; 95% CI, 4.5–9.2 kN) and torque to fracture at 16% of controls (mean difference, 333.7 N·m; 95% CI, 306.8–360.6 N·m). On torsional testing, all osteotomized femurs developed similar spiral fractures through a corner of the distal osteotomy site. This fracture pattern changed after prophylactic fixation with femurs developing nondisplaced fractures through the proximal osteotomy site. There were no underlying hardware failures during testing of osteotomized femurs with fixation. CONCLUSIONS AND RELEVANCE Anterolateral thigh osteomyocutaneous flap harvest results in significant changes in the structural integrity of the femur. Postoperative stabilization should be strongly considered, with future research directed at investigating the clinical significance of residual biomechanical changes following femur fixation.

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Intercalary defects reconstruction of the femur and tibia after primary malignant bone tumour resection. A series of 13 cases

Abstract: Level IV. Retrospective study.

Cited by 31 publications

References 35 publications

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

The vascularised fibular graft for limb salvage after bone tumour surgery

Association of the Anterolateral Thigh Osteomyocutaneous Flap With Femur Structural Integrity and Assessment of Prophylactic Fixation

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