Microsurgical Reconstruction in Limb-Salvage Procedures: Comparison between Primary and Secondary Reconstruction

Abstract

Limb-salvaging procedures after malignant tumor resection in the extremities were performed in 22 cases, utilizing microsurgical tissue transplantation. Five patients had soft-tissue tumors and 17 had bone tumors. Thirteen cases were primarily and nine were secondarily reconstructed. The advantages and disadvantages of both primary and secondary reconstructions were compared: as to technical difficulty, primary reconstruction was much easier. Chemotherapy was necessary just before and/or after reconstruction in eight of 13 cases of primary reconstruction. Delayed union or non-union occurred more frequently in patients who required chemotherapy, but eventual union was achieved in all cases by adding a conventional bone graft. As for oncologic and functional status, there was no difference in oncological status between the primary and secondary groups, but the primary reconstructions showed better functional results. Although individualized treatment is of utmost importance when utilizing microsurgical reconstruction to save limbs, primary reconstruction can be done most successfully when there is a wide surgical margin after tumor resection and when attention is paid to the avoidance of such complications as delayed union or non-union.

Megaprostheses after resection of distal femoral tumors: A rotating hinge design in 30 patients followed for 2-7 years

“…This finding was supported by a recent study of the effects of cisplatin on the incorporation of fresh syngeneic and frozen allogeneic cortical bone grafts in another rat model (Zart et al 1993), which showed that the total bone incorporation in chemotherapy-treated rats was less than in those which did not receive chemotherapy. While these 2 studies were confirmed by a report in humans (Usui et al 1993), that report found that eventual union occurred in all cases after further conventional bone grafts. In contrast, Aho et al (1994) and Wang (1 993) concluded that adjuvant chemotherapy had no major effect on the union rate of host-allograft bone.…”

Some Problems in Wrist Reconstruction after Tumor Resection with Vascularized Fibular-Head Graft

“…The cause in Case 4 appeared to be the ill effects of chemotherapy. 10 The causes of non-union in Case 5 appeared to be a small gap between the radius and grafted fibula and inadequate internal fixation due to the choice of too small a plate (see Fig. 3B).…”

Reconstruction by bone transport after resection of benign tumors of tibia

“…Vascularized autografts demand technical expertise and infrastructure which may be limited in many centres. 17 Allografts and recycled bone are also fraught with chances of infection, fracture, delayed incorporation, need for prolonged immobilisation and cannot be considered as definite options. Fresh frozen allografts are sparingly available and in addition carry risk of transmission of viral illnesses and immunological rejection.…”