Is combining massive bone allograft with free vascularized fibular flap the children's reconstruction answer to lower limb defects following bone tumour resection?

Jäger, Thomas; Journeau, Pierre; Dautel, G.; Barbary, S.; Haumont, T.; Lascombes, P.

doi:10.1016/j.otsr.2010.02.003

Cited by 32 publications

(13 citation statements)

References 14 publications

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“…The incidence of delayed union was less than 1%, comparatively lower than reported incidences ranging from 4% to 33.3% [7, 8, 20-23, 26, 29]. Partial weightbearing was allowed by 2.6 ± 1 months and full weightbearing ambulation was permitted by 12 ± 5 months, similar to those reported for 2 months [31] and 13 months [20][21][22][23]26] on average, respectively. The low incidence of delayed union and subsequent deformities between our two groups we believe is attributable to central placement of the vascularized fibula graft in the massive bone allograft shell followed by adequate and stable osteosynthesis [7,9,34].…”

Section: Discussionsupporting

confidence: 69%

“…Several studies involving middle and distal tibia reconstructions with pedicled fibula grafts alone have shown good results with the advantage of being less expensive, a technically easier procedure, associated with minimal complications, and with a predictable long-term clinical outcome [2, 11-13, 19, 30]. Other studies involving vascularized fibula and massive bone allograft constructs have shown similar advantages, focusing either on only free vascularized fibula [4,7,10,[21][22][23]31] or pedicled vascularized fibula with massive bone allografts [9,29]. However, to our knowledge, there are no published studies on indications or comparisons for free versus pedicled vascularized fibula grafts supplementing massive bone allografts in tibia diaphyseal sarcomas.…”

Section: Discussionmentioning

confidence: 99%

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Is There Benefit to Free Over Pedicled Vascularized Grafts in Augmenting Tibial Intercalary Allograft Constructs?

Manfrini

Bindiganavile

Say

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Intercalary reconstruction of tibial sarcomas with vascularized fibula autografts and massive bone allografts is reliable with predictable long-term results. However, inadequate data exist comparing free and pedicled vascularized fibula autografts in combination with a massive bone allograft in patients undergoing intercalary tibia reconstructions. Questions/Purposes Among patients undergoing largesegment intercalary allografting, we sought to compare supplemental free vascularized fibular autografts with supplemental pedicled vascularized fibular autografts, in terms of (1) oncologic results, (2) complications associated with surgery, (3) Musculoskeletal Tumor Society (MSTS) scores, and (4) surgical time. Methods Between 1994 and 2013, we treated 320 patients, younger than 40 years, with tibial sarcomas. Thirty-five patients (11%) underwent amputations. One hundred ninetyfive patients (61%) were treated with intraarticular resection of the tibia, which constituted 104 tumor endoprostheses, 63 proximal tibia allograft prosthetic composites, 21 osteoarticular allografts, and seven arthrodeses with allografts. Ninety patients (28%) underwent joint-sparing intercalary reconstruction. Forty-one (13%) of these 90 patients were treated with allografts alone, two (1%) with vascularized fibula grafts, and 47 (15%) with intercalary allografts supplemented by autografts (free fibular autografts, 22 patients, 7%; pedicled fibular autografts, 25 patients, 8%). During the study period, we used free vascularized fibular autografts in association with massive bone allograft for a resection longer than 12 cm with a very small periarticular residual segment. The choice for using a pedicled fibula harvested in the ipsilateral leg initially was for patients having only diaphyseal resections and the indication was later extended to intraepiphyseal osteotomies with a small periarticular residual segment. The goals of this study are to present the long-term results in this group of patients and compare their results based on the type of vascularized fibula harvest. There were 33 male and 14 female patients with mean age of 14 ± 6 years. The median followup was 84 months This study was supported by Italian Ministry of Health (Grant Minsal RF-2010-2321501 (range, 7-231 months). No patients were lost to followup before 1 year. Four patients died and were not available for followup after 18 months. The mean tibia resection length was 15 ± 4 cm and mean length of the harvested vascularized fibula was 18 ± 4 cm. Results Overall 5-and 10-year oncologic survival rates in this study were 87% ± 5% and 83% ± 6% respectively. With the numbers available, we observed no difference in survivorship free from death from disease between the study groups (85% ± 8% [95% CI, 174-232 months] of the free vascularized group versus 82% ± 8% [95% CI, 148-206 months] of the pedicled fibula graft group; p = 0.741). At last followup, 40 patients had no evidence of disease and seven had died of disease. Local recurrence was observed in two pa...

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Is There Benefit to Free Over Pedicled Vascularized Grafts in Augmenting Tibial Intercalary Allograft Constructs?

Manfrini

Bindiganavile

Say

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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“…Allograft reconstructions are associated with complications such as fracture, nonunion, and infection [15,24]. The transfer of vascularized bone from the fibula, with or without growth plate [19], is widely used to bridge large defects; however, donor-site morbidity has been reported to occur in as much as 19% of patients [27]. The relatively poor initial stability in adults owing to the thinness of the fibula has led some surgeons to resort to surrounding the vascularized fibula graft in an allograft shell [19].…”

Section: Discussionmentioning

confidence: 99%

“…The transfer of vascularized bone from the fibula, with or without growth plate [19], is widely used to bridge large defects; however, donor-site morbidity has been reported to occur in as much as 19% of patients [27]. The relatively poor initial stability in adults owing to the thinness of the fibula has led some surgeons to resort to surrounding the vascularized fibula graft in an allograft shell [19]. Vascularized bone transfer is more suitable for young children in whom initial stability is better, even though some with diaphyseal reconstruction also need a growth-plate transfer.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have supported the use of diaphyseal endoprostheses [1,14], allografts [5], bone transport [7], vascularized autografts [8,16], or combined use of allografts and vascularized autografts [18,19]. The goals of these treatments are to restore the original bone anatomy, provide a construct with the strength to withstand daily use, and potentially provide a mechanism for growth, such as seen with the use of vascularized epiphyseal transfer.…”

Section: Introductionmentioning

confidence: 99%

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Is the Induced-membrane Technique Successful for Limb Reconstruction After Resecting Large Bone Tumors in Children?

Fitoussi¹,

Ilharreborde

2015

Clinical Orthopaedics &Amp; Related Research

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Background Resection of primary malignant tumors often creates large bony defects. In children, this creates reconstructive challenges, and many options have been described for limb salvage in this setting. Studies have supported the use of an induced-membrane technique after placement of a cement spacer to aid in restoration of bone anatomy. Questions/purposes We asked: (1) What complications are associated with the induced-membrane technique? (2) How often is bone healing achieved after resection greater than 15 cm using this technique? (3) What is the functional outcome of patients treated with this technique?Methods We performed a retrospective evaluation of eight patients with a mean age of 13.3 years (range, 11-17 years) treated for a malignant bone tumor between 2002 and 2012 at our centers. The primary malignant tumors involved the proximal humerus, femur, and tibia. All patients were treated using the induced-membrane technique after a resection with mean bone loss of 18 cm (range, 16-23 cm). The general indication for using the induced-membrane technique during this time was a large diaphyseal defect after resection of the tumor. In addition to using cancellous graft as with the original technique, in the current patients an autogenous nonvascularized fibula was used to enhance stability. The patients were assessed at the last followup using the Musculoskeletal Tumor Society (MSTS) scoring system. Mean followup was 47.1 months (range, 24-120 months), and none of the patients were lost to followup before 2 years. Results A total of four unplanned reoperations were performed in these eight patients. A fracture of the reconstruction occurred in three patients and all were treated successfully, two with surgery and one with immobilization. Bone fusion was obtained in all patients within 4 to 8 months (mean, 5.6 months) after the reconstruction. The mean healing index was 0.31 month/cm of reconstruction (range, 0.23-0.5 month/cm). At last followup, the mean MSTS score was 74% (range, 67%-80%). Conclusions Our findings suggest that the modified induced-membrane technique is a reasonable alternative to other limb reconstruction techniques for bone tumors in children and has the advantage of not requiring a bone bank or an expensive metal prosthesis. Although more patients will be needed to substantiate our findings, it has become a standard part of our arsenal in the treatment of large bone defects after resection of pediatric primitive bone tumors.

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Biological Reconstruction of the Distal Femur—I: Massive Allograft and Inlaid Free Vascular Fibula

D’Arienzo

Colangeli

Andreani

et al. 2021

Orthopedic Surgical Oncology for Bone Tumors

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Is combining massive bone allograft with free vascularized fibular flap the children's reconstruction answer to lower limb defects following bone tumour resection?

Abstract: Level IV. Retrospective therapeutic study.

Cited by 32 publications

References 14 publications

Is There Benefit to Free Over Pedicled Vascularized Grafts in Augmenting Tibial Intercalary Allograft Constructs?

Is There Benefit to Free Over Pedicled Vascularized Grafts in Augmenting Tibial Intercalary Allograft Constructs?

Is the Induced-membrane Technique Successful for Limb Reconstruction After Resecting Large Bone Tumors in Children?

Biological Reconstruction of the Distal Femur—I: Massive Allograft and Inlaid Free Vascular Fibula

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