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

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.

Proximal femur reconstruction using a vascularized fibular epiphysis within a cadaveric femoral allograft in a child with Ewing sarcoma: a case report

“…Most bone sarcomas are localized to the metaphysis of the bone. In adults, the entire proximal or distal portion of the bone is resected and reconstructed with prostheses [8] . Diaphyseal bone defects can be reconstructed using megaprostheses and intercalar y allograf ts, both of which have high rates of postoperative complications such as nonunion, fracture, and infection [8][9][10] .…”

“…In adults, the entire proximal or distal portion of the bone is resected and reconstructed with prostheses [8] . Diaphyseal bone defects can be reconstructed using megaprostheses and intercalar y allograf ts, both of which have high rates of postoperative complications such as nonunion, fracture, and infection [8][9][10] . However, the Capanna technique can also be considered as a method to reconstruct bony defects through the use of a vascularized autograft set within a decellularized allograft, and has demonstrated positive outcomes in variety of cases [11] .…”

“…However, a fibular autograft alone would not provide the structural integrity needed to reconstruct the proximal femur and stabilize the hip joint [21] . The vascularized fibula within an allograft shell capitalizes on the immediate tensile strength of the allograft with the advantage of a biological autograft that can remodel and revascularize with the patient [8,11,15] . The patient's postoperative radiographs demonstrated bone healing and alignment and are likely to achieve complete union in the future.…”

“…Utilizing this method preserves the epiphyseal plate in a child, restoring both function and growth potential. Previous studies have combined acellular allografts with vascularized fibular autografts to reconstruct intercalary bony defects post-tumor resection [7][8][9][10] . However, there is a paucity of research on the reconstruction involving epiphyseal portions of long bones and articulations with this method [6] .…”

Simultaneous reconstruction of the bone and vessels for complex femoral defect

“…Several methods for bridging a massive femoral defect have been reported, including massive allografts [1], free vascularized fibula grafts (FVFG) [2], massive allografts with FVFG (Capanna method) [3], recycled autografts [4], recycled autografts with FVFG [5], and segmental prostheses [6]. …”