Non-vascularized fibular graft reconstruction after resection of giant aneurysmal bone cyst (ABC)

Abstract

The aim of this study was to present the results of non-vascularized fibular graft for reconstruction of bone defects after en block resection of giant aneurysmal bone cyst (ABC) of the extremities. Between 1998 and 2006, three patients, aged 6, 8 and 23 years, with giant aneurysmal bone cysts were treated. The cysts were located in the humerus, proximal femur and metatarsal. All patients were given en bloc resection of the cyst followed by non-vascularized fibular bone graft, with the graft length ranging from 6 to 18 cm. All patients needed supplementary fixation with a single Kirschner wire or plate and screws. At the final follow-up, bony union was achieved in each case, and there was no recurrence, limitation of range of motion or disability. In addition, complete regeneration of the fibula at the donor site was seen in the two children. We propose a criterion for giant ABC, when the transverse diameter of the cyst is up to three times or more of the transverse diameter of the nearby bone, it is then called a giant ABC. Non-vascularized fibular graft is an optimal and valuable method for the reconstruction of bone defects after resection of giant ABC in the extremities.

Giant recurrent aneurysmal bone cyst of the mandible

“…CT scan and MRI may not provide clear diagnostic criteria but only outline the extent of the lesion. [1011] This is because of the similarity of radiographic picture of these lesions to eosinophilic granuloma, giant cell tumor, non ossifying fibroma, Ewing's tumor, and in older patient metastatic carcinoma or myeloma.…”

“…[11] The usual treatment of choice is curettage as it is a benign lesion. But there is high recurrence rate (20-30%) reported in various studies.…”

“…But there is high recurrence rate (20-30%) reported in various studies. [91113] Other modalities of treatment have been tried, curettage followed by implantation with allograft chips, polymethyl methacrylate, autografts, cryotherapy, local injections of steroids, radiation therapy (Mega voltage, 26-30 Gy), injecting fibrosing agents, demineralized bone powder mixed with bone marrow aspirate introduced into the cyst to halt the expansion phase and to allow the cyst to ossify, segmental resection with use of rhBMP2 along with the rib graft has also given good results. [14] Segmental resection with immediate bone grafting with vascularised bone graft is suggested for extensive lesions such as the present case where a vascularised fibula flap was used to reconstruct the defect.…”

“…[14] Segmental resection with immediate bone grafting with vascularised bone graft is suggested for extensive lesions such as the present case where a vascularised fibula flap was used to reconstruct the defect. [1113] If untreated, such lesions can lead to pathological fracture and cosmetic deformities. Preoperative transcutaneous intralesional embolization has been tried recently prior to resection to produce a bloodless field.…”

A Comparison of Vascularized Free Fibular Flaps and Nonvascularized Fibular Grafts for Reconstruction of Long Bone Defects after Tumor Resection

“…Both flaps have been reported for the reconstruction of long bone defects after tumor resection with union rates ranging from 67 to 100% for vascularized free fibular flaps [10][11][12][13][14][15][16] and 76 to 89% for nonvascularized fibular grafts. [17][18][19][20][21][22][23][24] Most studies report on vascularized free fibular flaps and few studies directly compared vascularized and nonvascularized fibular transfer after tumor resection 25 even if both have been separately reported to have good results. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] This is probably because vascularized free fibular flaps have been reported with a high union rate in the reconstruction of long bone defects [10][11][12][13][14][15][16] and have been regarded as the treatment of choice for most reconstructions for long bone defects.…”