Intercalary reconstructions after bone tumor resections: a review of treatments

Abstract

An intercalary reconstruction is defined as replacement of the diaphyseal portion of a long bone after segmental skeletal resection (diaphysectomy). Intercalary reconstructions typically result in superior function compared to other limb-sparing procedures as the patient's native joints above and below the reconstruction are left undisturbed. The most popular reconstructive options after segmental resection of a bone sarcoma include allografts, vascularized fibula graft, combined allograft and vascularized fibula, segmental endoprostheses, extracorporeal devitalized autograft, and segmental transport using the principles of distraction osteogenesis. This article aims to review the indications, techniques, limitations, pros and cons, and complications of the aforementioned methods of intercalary bone tumor resections and reconstructions in the context of the ever-growing, brave new field of limb-salvage surgery.

Ilizarov External Fixation: Percutaneous Gigli Saw Versus Multiple Drill-hole Osteotomy Techniques for Distraction Osteogenesis

“…In the treatment of bone lengthening and bone transport, different types of low energy osteotomies have been described in the literature [8][9][10][11][12]. Gigli saw and MDH osteotomy has been recommended by many orthopedic surgeons because of better bone healing with minimal trauma to the soft tissue envelope at the osteotomy site [5][6]13].…”

Solitary Metastatic Lesion of the Tibia from Clear Cell Renal Carcinoma: A Case Report of Segmental Skeletal Resection, Intercalary Allograft Over Reamed Nailing and Soleus Flap Interposition

“…There are several options to achieve reconstruction and stabilization of segmental intercalary diaphyseal defects: (1) allografts [ 14 ], (2) free or pedicled vascularized fibula grafts [ 15 ], (3) combined allograft and vascularized fibula [ 16 ], (4) extracorporeal devitalized autograft [ 17 ], (5) distraction osteogenesis [ 18 ], and (6) segmental intercalary endoprosthesis [ 19 , 20 ].…”

“…Segmental endoprosthesis is another non-biological alternative for intercalary reconstructions that offers early weight bearing, rapid rehabilitation, and immediate stability. Nevertheless, healing is ignored and a significant risk of infection, periprosthetic fracture, aseptic loosening, and mechanical wear has been reported [ 13 , 19 , 20 ]. The 10-year survival of segmental endoprostheses ranges from 63% to 80%, with a reported 17–33% rate of implant failure [ 20 , 22 ]; therefore, in our opinion that method should be applied in elderly patients with poor healing capacity, patients with metastatic bone disease, or those with a very short life expectancy, in whom instant weight bearing and full function are more important than construct maintenance.…”

“…Nevertheless, healing is ignored and a significant risk of infection, periprosthetic fracture, aseptic loosening, and mechanical wear has been reported [ 13 , 19 , 20 ]. The 10-year survival of segmental endoprostheses ranges from 63% to 80%, with a reported 17–33% rate of implant failure [ 20 , 22 ]; therefore, in our opinion that method should be applied in elderly patients with poor healing capacity, patients with metastatic bone disease, or those with a very short life expectancy, in whom instant weight bearing and full function are more important than construct maintenance. The use of allograft reconstruction in oncological surgery was first reported 50 years ago and has been popular ever since, especially with the establishment of organized tissue banks and the minimization of justifiable concerns regarding immunogenicity, antigenicity, and potential disease transmission.…”

RECONSTRUCTION OF BONE DEFECTS AFTER TUMOR RESECTION BY AUTOAND ALLOGRAFTS (review of literature)

“…Доброкачественным или злокачествен-ным является удаленное образование. этот аспект обуславливает хирургическую такти-ку резекции пораженного участка (соблюдение норм абластичности) и дальнейшее медицинское сопровождение в послеоперационном периоде [7][8][9][10][11][12][13][14][15][16][17][18][19].…”