The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy

Li, Jing; Wang, Zhen; Guo, Zheng; Chen, Guojing; Fu, Jun; Pei, Guoxian

doi:10.1002/jso.21620

Cited by 57 publications

(62 citation statements)

References 46 publications

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“…26 Fracture rates for fibula flap reconstruction in combination with a massive allograft have been reported at up to 29 percent; nonunion rates are reported to range from 9 percent to 31 percent, infection rates are up to 23 percent, and in one series, flap loss was reported as 6.5 percent. 12,[27][28][29] Our functional results and complication rates compare favorably with the rates quoted in the literature.…”

Section: Plastic and Reconstructive Surgery • August 2015supporting

confidence: 83%

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

Weichman

Dec

Morris

et al. 2015

Plastic and Reconstructive Surgery

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Section: Plastic and Reconstructive Surgery • August 2015supporting

confidence: 83%

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

Weichman

Dec

Morris

et al. 2015

Plastic and Reconstructive Surgery

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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%

“…The overall MSTS scores for our patients were comparable to those of massive bone allograft with vascularized fibula ranging between 23 and 27 [4,7,8,20,22,23], whereas one study, in which only pedicled versus free fibula grafts alone were compared, showed poor MSTS scores and overall outcomes for the pedicled graft group [6]. With the numbers we had, we could not show a difference in MSTS scores between the free fibula and the pedicled fibula groups.…”

Section: Discussionmentioning

confidence: 58%

“…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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“…Although others have reported earlier times to union (mean 5.4 months), they have also noted a prolonged time to full weight-bearing (mean 12.4 months), but with a functional score of 92%. 25 The technique of excision, irradiation and reimplantation has the advantage of being a biological reconstruction with the potential for long-term survival. 26 It is cheap and convenient, but requires the proximity of a radiotherapy department.…”

Section: Discussionmentioning

confidence: 99%

Biological reconstruction after excision, irradiation and reimplantation of diaphyseal tibial tumours using an ipsilateral vascularised fibular graft

Mottard

Grimer

Abudu

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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The purpose of this study was to assess the outcome of 15 patients (mean age 13.6 years (7 to 25)) with a primary sarcoma of the tibial diaphysis who had undergone excision of the affected segment that was then irradiated (90 Gy) and reimplanted with an ipsilateral vascularised fibular graft within it. The mean follow-up was 57 months (22 to 99). The mean time to full weight-bearing was 23 weeks (9 to 57) and to complete radiological union 42.1 weeks (33 to 55). Of the 15 patients, seven required a further operation, four to obtain skin cover. The mean Musculoskeletal Society Tumor Society functional score at final follow-up was 27 out of 30 once union was complete. The functional results were comparable with those of allograft reconstruction and had a similar rate of complication. We believe this to be a satisfactory method of biological reconstruction of the tibial diaphysis in selected patients.

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The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy

Cited by 57 publications

References 46 publications

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

Lower Extremity Osseous Oncologic Reconstruction with Composite Microsurgical Free Fibula Inside Massive Bony Allograft

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

Biological reconstruction after excision, irradiation and reimplantation of diaphyseal tibial tumours using an ipsilateral vascularised fibular graft

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