Vascularized Bone Graft Reconstruction Following Bone Tumor Resection at a Multidisciplinary Sarcoma Center: Outcome Analysis

Abstract

Background/Aim: Limb-sparing procedures are frequently applied to improve patient outcomes. The use of vascularized bone grafts is associated with significant improvements in oncologic safety and functional satisfaction. This study highlights the clinical outcomes following tumor resection combined with vascularized bone graft reconstructions. Patients and Methods: Twenty-five free vascularized bone grafts (17 fibulas, 5 iliac crests, 3 medial femoral condyles) were assessed with respect to consolidation and hypertrophy, functional and oncologic outcomes, and local complications. Results: The rate of healing of fibular grafts after a median of 5 months was 86%. The rate of achieved unions of iliac crest grafts after a median of 5 months was 80%. In medial femoral condyle bone grafts, union occurred after a median of 4 months. Significant hypertrophy was observed in 13 patients. We identified six complications with highest rates in the fibulagroup. Despite the high complications, functional results were highly satisfactory. Conclusion: Vascularized bone grafts represent a reconstructive approach, maintaining long-term functionality and cosmetic satisfaction without compromising tumor recurrence outcomes.With an estimated annual incidence rate of 0.8 cases per 100,000 individuals, bone sarcomas represent a rare tumor entity (1). Among children aged 0-14 years, however, bone sarcomas account for approximately 4-6% of all childhood malignancies (2). Since prognosis has improved for bone tumor patients, surgical interventions have changed towards limb-sparing procedures that maintain oncologic safety in combination with function and appearance (3, 4). Various reconstructive procedures have been developed, including allografts (5-7), autografts using non-vascularized (8, 9) or vascularized tissues (10-12), and tumor endoprostheses (13,14). According to oncological guidelines, the decision on whether a surgical intervention is indicated should be carefully evaluated on a case-by-case basis in an interdisciplinary tumor board, and biological reconstruction should be preferred in children, adolescents, and young adults.The use of non-vascularized bone grafts has been the mainstay in biological reconstruction. This approach does not require microsurgical expertise, and clinical advantages include shorter operative time, low complication rates, and the possibility of remodeling at the donor site (8, 9). In practice, similar outcomes can be achieved with both vascularized and non-vascularized bone grafts for reconstruction of segmental bone defects following diaphyseal tumor resection (15). In the decision to vascularize a graft, the length of the defect is an important factor to consider in order to avoid graft failure and revision surgery. Lenze et al. revealed that the use of nonvascularized bone grafts is especially recommended to segmental defects of less than 12 cm in which no concomitant use of chemotherapy is required (9).Tumor excision often results in extensive bone defects and, in cases where bone tumors are close...

Vascularized and Non-vascularized Fibula Grafts in Tumour Reconstruction: Single Centre Experience With Mid to Long-term Results

“…Patients in the VFG group showed bony union in 86% at the proximal osteotomy, and in 64% at the distal osteotomy sites. As previously shown in our outcome analysis of vascularized bone graft reconstruction in bone tumour patients (7), delayed union was primarily influenced by the concomitant use of radio-and chemotherapy, which is a detrimental effect on bony union. Additionally, we believe that the poor vascular supply at the distal part of the tibia could also determine the delayed union at the distal osteotomy sites (13).…”

“…Nevertheless, conventional grafts have limited indications compared to VFG. Vascularized bone grafts from the fibula, on the other hand, have a preserved vascular supply and therefore increase the likelihood of bony consolidation, particularly in patients with substantial bone defects (>12 cm) and a concomitant use of chemo-and radiotherapy (7).…”

Kết Quả Phẫu Thuật Bảo Tồn Chi Bằng Cắt Rộng Bướu Xương Và Ghép Xương Mác Có Cuống Mạch

“…Kết quả này cũng tương đồng với các nghiên cứu khác. Gebert (85%) [6], Gorski 86,7% ở chi dưới và 84,4% ở chi trên [9]. Nhìn chung kết quả chức năng chi đã được báo cáo là 78-92% cho ghép xương mác có cuống mạch máu [2], [6], [9], [10].…”

Surgical Treatment of Bone Sarcoma

“…In the context of limb-salvage surgery, reconstruction of bone defects with vascularized grafts, especially the fibula [ 62 , 63 ], plays an important role (an example is displayed in Figure 3 ). Gorski et al [ 64 ] reported a case series of 25 free vascularized bone grafts (17 fibulae, 5 iliac crests, 3 medial femoral condyles). Seven of these patients had been treated for Ewing sarcoma.…”