Abstract
BackgroundReconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of a vital autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation.MethodsTwenty-one patients with 22 reconstructions were included. In all cases, the bone tumor was resected with wide margins and in 21 of them irradiated with 300 Gy. In the first case, thermal sterilization in an autoclave was used. The autograft was orthotopically replanted and stabilized with plates and screws. Fifteen patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a locally pedicled fibular interposition.Resultsthe most common diagnosis was a Ewing sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months (16–154 months). For our statistical analysis, the one case with autoclave sterilization and 3 patients with tumors in small bones were excluded. During follow-up of 18 cases, 55.6% of patients underwent an average of 1.56 revision surgeries. Complete bony integration of the irradiated autografts was achieved in 88.9% of cases after 13.6 months on average. In those cases with successful reintegration, the autograft was shorter (n.s.). Microvascular anastomosis in vascularized fibular strut grafts did not significantly influence the rate of pseudarthrosis.Conclusionsthe replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors that allow for joint preservation. However, these patients should be ready to accept longer treatment periods.
Highlights
Reconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft
Most primary malignant bone tumors are localized in the long bones with the majority occurring in the meta −/epiphyses whereas about 10% affect the diaphyseal part of the long bones [1]
The aim of our study was to evaluate the outcomes of the treatment of malignant bone tumors by replantation of the extracorporeally irradiated bone segments, to establish the rate of successful bone healing and to evaluate the role of fibular augmentation of the reconstruction
Summary
Reconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. Most primary malignant bone tumors are localized in the long bones with the majority occurring in the meta −/epiphyses whereas about 10% affect the diaphyseal part of the long bones [1] The resection of these tumors causes large defects in these load-bearing bones and their reconstruction represents a challenge. Our center has a longstanding experience with the sterilization of tumorbearing bone autografts by irradiation This technique was first described by Spira et al in 1968 [3] and has since become established in the treatment of malignant bone tumors. It allows for an anatomic reconstruction and later bone remodeling especially in young patients [4]. There are only few reports with series including more than 15 patients
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