Bone Defects Of Lower Extremity Research Articles

Ilizarov method and its combined methods in the treatment of long bone defects of the lower extremity: systematic review and meta-analysis

BackgroundIlizarov method has become one of primary methods for treating bone defects. Currently, there is growing trend in the application of modified Ilizarov methods (e.g., applying unilateral external fixators or with flap tissue) and its combined methods (e.g., Ilizarov method with antibiotic spacer or internal fixation) to manage bone defects. However, there is a lack of studies with systematical evaluation of the clinical effects of these evolving methods. This study aimed to conduct a systematic review and meta-analysis for overall evaluating the clinical effects on long bone defects of lower extremity in Ilizarov methods and its combined methods.MethodsStudies were identified in three electronic databases (Pubmed, Embase and Cochrane Library) from the earliest indexing year through November 01, 2022, and relevant data were extracted subsequently. The total number of participants, number of participants with bone unions, bone result or functional result, and related complications including pin infection, pin loosening, pain, refracture, limb discrepancy, malalignment, joint stiffness, recurrent infection, and amputation were extracted in this study. Then, union rate (defined as the proportion of patients who achieved bone unions) and specific complication incidence rate (defined as the proportion of patients who experienced specific complication) were pooled estimated respectively. Relative risk (RR) was used for comparing the clinical effects among various Ilizarov technique.ResultsSixty-eight case series studies, 29 comparative studies, and 3 randomized clinical trials were finally included. The union rate of Ilizarov methods was 99.29% (95% CI: 98.67% ~ 99.86%) in tibial defects and 98.81% (95% CI: 98.81% ~ 100.00%) in femoral defects. The union rate of Ilizarov method with antibiotic spacer and intramedullary nail in tibial defects was 99.58% (95% CI: 98.05% ~ 100.00%) and 95.02% (95% CI: 87.28% ~ 100.00%), respectively. Compared to the Ilizarov methods, the union rate of the Ilizarov method with antibiotic spacer in tibial defects increased slightly (RR = 1.02, 95% CI: 1.01 ~ 1.04). Meanwhile, compared to Ilizarov methods, we found lower excellent rate in bone result in Ilizarov method with antibiotic spacer, with the moderate to high heterogeneity. Compared to the Ilizarov method, lower rate of pin infection, higher rate of recurrent infection and amputation were observed in Ilizarov method with intramedullary nail, however, the findings about the comparison of pin infection and recurrent infection between the two groups were presented with high degree of statistical heterogeneity.ConclusionOur study confirmed the reliable treatment of Ilizarov methods and its combined technique on long bone defects, and founded there were significant differences on some complications rate between Ilizarov methods and its combined technique. However, the findings need to be confirmed by further studies.

Predictive factors for docking site procedure in bone transport for large lower extremity segmental defects

BackgroundSegmental bone transport is a common technique for treating large segmental bone defects. However, a docking site procedure is often necessary in segmental bone transport. To date, no prognostic factors for the need of docking site procedure have been reported. Thus, the decision is often made at random, based on the surgeon’s subjective judgment and experience. The aim of this study was to identify prognostic factors for the need of docking site operation.MethodsPatients with segmental bone transport in lower extremity bone defects were included regardless of age, aetiology, and defect size. We excluded patients undergoing treatments that were not yet completed, and those who discontinued therapy by any reason. The need for docking site operation was modelled with logistical and linear regression as well as univariate analysis of variances (ANOVA). Receiver operating characteristics (ROC) curve analysis was also performed.ResultsTwenty-seven patients from age 12 to 74 years (mean age: 39.07 ± 18.20 years) were included. The mean defect size was 76.39 ± 41.10 mm. The duration of transport (days) showed a significant influence (p = 0.049, 95%CI: 1.00–1.02) on the need for docking site operation. No other significant influences were detected.ConclusionA link between the duration of transport and the need for docking site operation was detected. Our data showed that if a threshold of about 188 days is exceeded, docking surgery should be considered.

Case Report: Large bone defect reconstruction in lower extremities with ipsilateral transposition fibular graft with combined inlay and onlay technique using plate and screw fixation (fibula pro tibia technique)

Introduction: Management of large bone defect is a challenging problem. Hahns, in 1884, introduced the first use of fibula pro tibia to bridge a large defect of the tibia due to chronic osteomyelitis. In this case, we did a transposition of the ipsilateral fibular with inlay and onlay technique using a locking plate and screw into the defect of the tibia. Case presentation: A 20-year-old male came to our emergency department at RSUD Dr. Saiful Anwar, Malang, Indonesia with an open fracture grade III B of his left lower leg. We found a large defect of the tibia approximately 7.5 cm after regular wound care for ten months. Then, we performed ipsilateral transposition fibular graft with combined inlay and onlay technique using a locking plate and screw fixation. No infections occurred and there was progressive callus formation with extending ossification along the periosteal tissue in the four-month postoperative evaluation. There was no leg length discrepancy, and the union sign showed that the patient could achieve full range of movement (ROM) and walk with crutches without pain with a Lower Extremity Functional Scale (LEFS) score of 62. Discussion: Contralateral fibula graft carries a high risk of endangering the unaffected limb. The ipsilateral fibula can be utilized to replace the missing segment with minimal morbidity. The purpose of combining ipsilateral fibular transport with the inlay and onlay technique is to minimalize the gap defect between fracture fragments, therefore enhancing the union rate of the bone. Conclusion: The fibula pro tibia technique can be used as an alternative treatment option for large gap bone defects in lower extremities with minimal complication.

Novel piston technique versus Ilizarov technique for the repair of bone defect after lower limb infection

BackgroundWe aimed to compare the effectiveness and complications of a novel piston technique versus the Ilizarov technique for the repair of bone defects after lower limb infection.Patients and methodsWe retrospectively reviewed 41 patients who had been treated at our department for lower extremity bone defects following osteomyelitis. There were 38 men and three women with a mean age of 43.41 (range, 12–69 years). The infected bone defects involved 36 tibias and five femurs. The piston technique (PT, group A) was used in 12 patients and the Ilizarov technique (IT, group B) in 29 patients. The mean follow-up period was 28.50 months (PT) and 29.90 months (IT). The modified Application of Methods of Illizarov (ASAMI) criteria was used to evaluate bone healing and functional recovery.ResultsComplete eradication of the infection and union of docking sites were accomplished in both groups. The mean external fixator index (EFI) was 42.32 days/cm in group A versus 58.85 days/cm in group B (p < 0.001). The bone outcomes were similar between groups A and B (p = 0.558) (excellent [9 vs. 19], good [3 vs.10]); group A showed better functional outcomes than group B (p < 0.05) (excellent [7 vs. 6], good [4 vs. 12], fair [0 vs. 10] and poor [1 vs. 1]). Pain was the most common complaint during follow-up, and group A had fewer cases of pin tract infection (1 vs. 6), adjacent joint stiffness (3 vs. 8), and delayed healing of the joint (0 vs. 3).ConclusionsSatisfactory bone healing can be achieved by using both PT and IT, although PT demonstrated better functional results, lower EFI, and allowed early removal of the external fixation. We found that this novel piston technique can improve the comfort of patients, reduce the incidence of complications, and provide rapid and convenient rehabilitation.

Аддитивные технологии у пациентов с обширными дефектами костей нижних конечностей

Augments and reinforcing constructs made of titanium with a porous coating have been used for bone defect management in addition to osteoplastic materials. Additive technologies in traumatology and orthopedics for extensive defects in bones and joints have been applied when it is impossible to use standard designs. The purpose of the study was to evaluate short-term results and perspectives of using additive technologies for bone defects after failed joint arthroplasties and osteosynthesis. Materials and methods In 2018 to November 2019, seven patients with lower extremity bone defects underwent treatment at the Department of Traumatology and Orthopedics of the Moscow Regional Research and Clinical Institute with custom-made implants fabricated with additive technologies. The operations were carefully planned using CT scans, 3D modeling, and implant printing. Particular attention was paid to clean the implant from residual metal powder. Patients were distributed depending on the type of defect and the operation performed (arthroplasty, revision arthroplasty). Results The short-term results of using customized implants were analyzed in this study. The average Harris hip score before surgery was 37.8 points, and after the surgery it was 80.2 points. Pain after surgery in all patients was also evaluated by Harris scale and was 37.1 points; the functionality of patients after surgery was 38.4 points. The custom-made designs have a number of distinguishing advantages against the standard ones. A customized anatomical design provides easier fixation; ergonomic design allows implant retention without removing metal fixators if exist; there is less soft tissue injury during surgery (allinside principle); and convenient bone grafting around the implant. Conclusions The use of additive technologies for bone defects improves the functional results and life quality of the patient. At the moment, practical application of 3D designs has a number of limitations in financial and legal support in practical health care. Further implementation of additive technologies in traumatology and orthopedics will be supported by the grant from the President of the Russian Federation.

Novel 3D-printed prosthetic composite for reconstruction of massive bone defects in lower extremities after malignant tumor resection

ObjectiveTo introduce a novel 3D-printed prosthetic composite for reconstruction of massive bone defects after resection for bone malignancy of lower extremities. The design concept, surgical technique, and the preliminary outcomes were elaborated. MethodsPatients with primary malignant tumors of lower extremities requiring tumor resection and reconstruction were recruited between Jun 2015 and Nov 2018. Patient-specific 3D-printed prostheses were designed according to preoperative imaging data. After tumor resection, reconstruction was performed with composites consisting of 3D- printed prosthesis, beta-tricalcium phosphate (β-TCP) bioceramics and/or vascularized fibula. All patients underwent regular follow-up postoperatively. The functional outcomes were assessed by the Musculoskeletal Tumor Society score (MSTS). Oncological outcomes, imaging results, and complications were recorded and analyzed. ResultsTen cases averaging 12.90 years of age participated in this study. There were five femur and five tibia reconstructions. The mean follow-up period was 16.90 months. At last follow-up, all patients were alive without tumor recurrence. Average MSTS functional score was 80.33 ± 11.05%. All prostheses were intact and stable without failure or systemic breakage. No serious complications occurred after the operation. Postoperative X-ray, computed tomography (CT) and single-photon emission computed tomography (SPECT) showed an ideal integration between the bone and the prosthetic composite. Moreover, vascularized fibula and implanted β-TCP bioceramics indicated relatively high metabolic activity in vivo. ConclusionsPatient-specific 3D-printed prostheses combined with β-TCP bioceramics and/or vascularized fibula provide an excellent option for reconstruction of massive bone defects after lower extremity malignant tumor extirpation. Short-term follow up showed promising clinical results in recovering lower limb function, promoting osseointegration and reducing complications.

Masquelet technique versus Ilizarov bone transport for reconstruction of lower extremity bone defects following posttraumatic osteomyelitis

ObjectiveThis study was to compare the effectiveness of Masquelet technique versus Ilizarov bone transport in the treatment of lower extremity bone defects following posttraumatic osteomyelitis. Patients and methodsWe retrospectively reviewed 39 patients who had been treated at our department for lower extremity bone defects following posttraumatic osteomyelitis. They were 30 males and 9 females with a mean age of 39.18 (range, 12–63 years). The infected bone defects involved 26 tibias and 13 femurs. The mean length of the bone defects after radical debridement was 6.76cm (range, 2.7–15.7cm). Masquelet technique (MT, group A) was used in 20 patients and Ilizarov bone transport (IBT, group B) in 19 ones. The measurements were bone outcomes (union, deformity, infection and leg-length discrepancy) and functional outcomes (significant limping, joint contracture, soft tissue dystrophy, pain and inactivity). ResultsThe mean follow-up after removal of the apparatus was 25.26 months (range, 14–51 months). The mean finite fixator time was 10.15 months (range, 8–14 months) in group A versus 17.21 months (range, 11–24 months) in group B. The bone outcomes were similar between groups A and B [excellent (5 vs. 7), good (10 vs.9), fair (4 vs. 2) and poor (1 vs. 1)]; group A showed better functional outcomes than group B [excellent (8 vs. 3), good (9 vs. 6), fair (3 vs. 8) and poor (0 vs. 2)]. ConclusionsIn the treatment of segmental lower extremity bone defects following posttraumatic osteomyelitis, both IBT and MT can lead to satisfactory bone results while MT had better functional results, especially in femoral cases. IBT should be preferred in cases of limb deformity and MT may be a better choice in cases of periarticular bone defects.

Tissue flap combined with sequential bone lengthening technique for repairing severe soft tissue and bone defects of lower extremity after burn injury

To investigate the effectiveness of tissue flap grafting and sequential bone lengthening for repairing severe soft tissue and bone defects of the lower extremity after burn injury. Between January 2010 and December 2015, 11 cases of large segmental bone and soft tissue defects in the leg were treated. There were 10 males and 1 female, with a mean age of 28 years (range, 19-37 years). The causes included traffic accident in 8 cases, high voltage electric burn in 2 cases, CO poisoning burn in 1 case. The time from injury to admission was 3-14 days (mean, 6.5 days). The bone defect length was 8-18 cm (mean,14 cm); the skin soft tissue defect ranged from 13 cm × 8 cm to 25 cm × 19 cm. After complete removal of necrotic tissue and lesions of the femur or the tibia, the tissue flaps were used to repair soft tissue defect of the lower extremity in one-stage operation; bone defect was treated by Orthofix single side external fixation or Ilizarov ring external fixation in two-stage operation. Eleven flaps survived completely, primary healing of incision was obtained in the others except for 1 patient who had necrotic bone infection, which was cured after removing necrosed femoral bone and filling with antibiotic bone cement spacer. During bone lengthening, pin tract infection occurred in 1 patient, and infection was controlled after dressing change. Bone lengthening ranged from 8 to 18 cm, with an average of 14 cm. After prolonged extension, the external fixator was retained for 4-12 months (mean, 6.5 months). All bone defects were repaired with bone healing time of 12-22 months (mean, 17 months). All patients were followed up 8-24 months (mean, 15 months). No vascular and neurological complication occurred during operation; no osteomyelitis or re-fracture occurred after operation, and the recovery of the lower extremity function was good. Tissue flap grafting combined with bone lengthening is an effective method to repair severe bone and soft tissue defects of lower extremity.

Reconstruction of septic diaphyseal bone defects with the induced membrane technique

AbstractSeptic segmental bone voids of the diaphysis are difficult to manage. The induced membrane technique by Masquelet has been successfully used to reconstruct segmental defects more than 20cm.Our article describes a series of 13 cases with extensive posttraumatic bone loss of the metatarsal, tibial, femoral and radial bones after septic injuries followed by multiple surgical interventions. Antibiotic-impregnated polymethyl methacrylate (PMMA) cement spacers were implanted after successful eradication of bacterial infections of soft tissue and bones. After a mean of 9.8 weeks, body-induced membranes were established and the cements spacers removed. To fill up the bone void, cancellous bone autografts were implanted into the membranes.The follow-up examination after 24 months revealed bony union in all cases and favorable functional results.The induced membrane technique has shown to be effective in treating bone defects of upper and lower extremity bone defects.

Segmental Bone Transport with the Monorail Technique in Reconstructing a Bone Defect in the Forearm: A Case Report.

Management of posttraumatic segmental bone loss can be challenging. The reconstruction of such defects requires an infection-free zone as well as stable and reliable fixation. The variety of reconstruction methods reflects the complexity in achieving healing in the gap left by bone loss. Distraction osteogenesis, autogenous or allogenic bone-grafting, segmental bone transport, and vascularized and nonvascularized bone transfers are all well-recognized methods of treatment. Most of the associated literature is focused on lower-extremity bone defects; reports of upper-limb bone loss are rare. We used the monorail technique, a combination of an unreamed interlocking intramedullary nail (Wurzburger nail-TREU) and a unilateral external fixator (Wagner apparatus), for transporting a bone segment to reconstruct a 7-cm long posttraumatic bone defect in the radius, which was complicated because of osteomyelitis. The patient achieved full healing and had improved forearm and hand function, but there was some loss of forearm rotation. To the best of our knowledge, use of this technique in reconstructing forearm bone defects has not previously been reported. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A twenty-five-year-old man was brought to our trauma center after a motorbike accident. The initial assessment was remarkable only for closed multifragmentary diaphyseal fractures of the left radius and ulna (AO classification 22-C1.2); a displaced olecranon fracture was also evident, as well as early signs and symptoms of compartment syndrome (Fig. 1). Fig. 1 Closed displaced diaphyseal fractures of the left radius and ulna as well as a displaced olecranon fracture are evident. The patient underwent surgery on the same day. The procedure involved fracture fixation with two 3.5-mm locking compression plates (LCPs) and a tension band for the olecranon fracture (Fig. 2). The wound on the volar aspect of the forearm, which was left open after …

Modified Classification and Single-Stage Microsurgical Repair of Posttraumatic Infected Massive Bone Defects in Lower Extremities

Posttraumatic infected massive bone defects in lower extremities are difficult to repair because they frequently exhibit massive bone and/or soft tissue defects, serious bone infection, and excessive scar proliferation. This study aimed to determine whether these defects could be classified and repaired at a single stage. A total of 51 cases of posttraumatic infected massive bone defect in lower extremity were included in this study. They were classified into four types on the basis of the conditions of the bone defects, soft tissue defects, and injured limb length, including Type A (without soft tissue defects), Type B (with soft tissue defects of 10 × 20 cm or less), Type C (with soft tissue defects of 10 × 20 cm or more), and Type D (with the limb shortening of 3 cm or more). Four types of single-stage microsurgical repair protocols were planned accordingly and implemented respectively. These protocols included the following: Protocol A, where vascularized fibular graft was implemented for Type A; Protocol B, where vascularized fibular osteoseptocutaneous graft was implemented for Type B; Protocol C, where vascularized fibular graft and anterior lateral thigh flap were used for Type C; and Protocol D, where limb lengthening and Protocols A, B, or C were used for Type D. There were 12, 33, 4, and 2 cases of Types A, B, C, and D, respectively, according to this classification. During the surgery, three cases of planned Protocol B had to be shifted into Protocol C; however, all microsurgical repairs were completed. With reference to Johner-Wruhs evaluation method, the total percentage of excellent and good results was 82.35% after 6 to 41 months of follow-up. It was concluded that posttraumatic massive bone defects could be accurately classified into four types on the basis of the conditions of bone defects, soft tissue coverage, and injured limb length, and successfully repaired with the single-stage repair protocols after thorough debridement.

Clinical observation of biological artificial material-induced artificial bone in repair of lower extremity bone defects

Objective To observe the clinical effects of biological artificial material (BAM)induced artificial bone in the repair of lower extremity bone defects. Methods The study involved 32 patients with lower extremity bone defects treated by BAM artificial bone grafting from January 2008 to December 2010.Their age was at a range of 21-77 years (mean,32.5 years).The volume of bone defects was 1.0 cm × 2.0 cm × 2.5 cm-3.0 cm × 3.5 cm × 5.0 cm ( mean,15.4 cm3 ).The main causes of bone defects were comminuted fracture,bone cyst,fibrous dysplasia,and chronic osteomyelitis.A followup was performed immediately after the surgery and at 1,2,3,5,7,9,12,18 months after surgery to observe the systemic and local reactions,changes of blood calcium/phosphorus,repair of bone defect and restoration of function of the affected extremity. Results All patients were followed up for 9-18 months (mean,10.5 months).There were no local or systemic grafts rejection from the postoperative period to the last follow-up.Follow-up X-ray films showed fuzzy boundary of BAM artificial bone implantation area and bone tissues around bone defects three months postoperatively and new bone formation. Apparent bone ingrowth into the BAM artificial bone implantation area,integrated artificial bone materials and bone tissues,and basically repaired bone defects were founded six months postoperaively.The time for full weight-bearing of the affected extremity was on postoperative 2.5-4 months ( mean,3.2 months). Conclusion BAM artificial bone is characterized by good biocompatibility,osteogenesis effect and a certain stiffness and strength of inner structure and can he used to repair the lower extremity bone defects. Key words: Bones of lower extremity; Biocompatible materials; Bone defect

Versatility of Chimeric Flap based on Thoracodorsal Vessels Incorporating Vascularized Scapular Bone and Latissimus Dorsi Myocutaneous Flap in Reconstructing Lower-extremity Bone Defects due to Osteomyelitis

Versatility of Chimeric Flap based on Thoracodorsal Vessels Incorporating Vascularized Scapular Bone and Latissimus Dorsi Myocutaneous Flap in Reconstructing Lower-extremity Bone Defects due to Osteomyelitis

Segmental transports for posttraumatic lower extremity bone defects: are femoral bone transports safer than tibial?

The long-term outcomes following femoral and tibial segment transports are not well documented. Purpose of the study is to compare the complication rates and life quality scores of femoral and tibial transports in order to find what are the complication rates of femoral and tibial monorail bone transports and if they are different? We retrospectively analyzed the medical records of 8 femoral and 14 tibial consecutive segment transports performed with the monorail technique between 2001 and 2008 in our institution. Mean follow-up was 5.1 ± 2.1 years with a minimum follow-up of 2 years. Aetiology of the defects was posttraumatic in all cases. Four femoral (50%) and nine tibial (64%) fractures were open. The Short Form-36 (SF-36) health survey was used to compare the life quality after femoral and tibial bone transports. The Mann-Whiney U test, Fisher exact test, and the Student's two tailed t-test were used for statistical analysis. P ≤ 0.05 was considered to be statistically significant. The tibial transport was associated with higher rates of severe complications and additional procedures (1.5 ± 0.9 vs. 3.4 ± 2.7, p = 0.048). Three patients of the tibial group were amputated because of recurrent infections and one developed a complete regenerate insufficiency that was treated with partial diaphyseal tibial replacement. Contrary to that none of patients of the femoral group developed a complete regenerate insufficiency or was amputated. Tibial bone transports have a higher rate of complete and incomplete regenerate insufficiency and can more often end in an amputation. The authors suggest systematic weekly controls of the CRP value and of the callus formation in patients with posttraumatic tibia bone transports. Further comparative studies comparing the results of bone transports with and without intramedullary implants are necessary.

Versatility of Chimeric Flap based on Thoracodorsal Vessels Incorporating Vascularized Scapular Bone and Latissimus Dorsi Myocutaneous Flap in Reconstructing Lower-extremity Bone Defects due to Osteomyelitis

To treat lower-extremity osteomyelitis secondary to trauma, bone and soft tissue can be grafted at the same time using microsurgical techniques. We investigate the use of chimeric flaps based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous flap to reconstruct bone and soft-tissue defects of the lower leg due to osteomyelitis. Ten patients with lower-extremity bone and soft-tissue defects due to osteomyelitis were treated. Vascularized scapular bones were raised on the angular branch of the thoracodorsal artery. Latissimus dorsi myocutaneous flaps were elevated simultaneously to reconstruct the soft tissue defects. All patients tolerated the procedure well. One patient developed an early venous thrombosis, which was successfully treated by thrombectomy. Mean follow-up time was 7 years and 8 months. Bone union without refracture was observed in all patients. The mean time required for bone union after surgery was 13.5 weeks. Donor-site morbidity was minimal. Chimeric flaps based on thoracodorsal vessels incorporating vascularized scapular bone and latissimus dorsi myocutaneous are safe and effective in the repair of lower-extremity bone and soft-tissue defects caused by osteomyelitis.

Homeochronous Usage of Structural Bone Allografts with Vascularized Fibular Autografts for Biological Repair of Massive Bone Defects in the Lower Extremities after Bone Tumor Excision

We report the clinical outcomes of homeochronous usage of massive bone allografts with vascularized fibular autografts for the biological repair of lower-extremity bone defects secondary to bone tumor excision. Large bone defects in the lower extremities of 17 patients (10 men and seven women; age range, 6 to 34 years) who underwent bone tumor excision were repaired using massive bone allografts along with vascularized fibular autografts. After 6 to 48 months (mean, 20.2 months) of follow-up, the wounds at the donor and recipient sites healed in one stage, the monitoring flaps remained viable, the immune response to the massive bone allografts was minimal, and there were no complications in the donor limbs. Of the 17 patients, 13 and 3 cases showed radiographic union in 6 months and 8 months after surgery, respectively; one case of malignant synovioma showed recurrence, and therefore, leg amputation was performed 2.5 months after surgery. None of the massive bone allografts were absorbed or fractured at the last follow-up. The Mankin evaluation rating was excellent in eight cases, good in five cases, fair in two cases, and poor in two cases; the total rate of excellent and good cases was 76.47%. Homeochronous usage of massive bone allografts with vascularized fibular autografts is a satisfactory method for the biological repair of massive bone defects in the lower limbs after bone tumor excision.

Reconstruction of lower extremity bone defects after bone tumor resection using free vascularized fibular transfer with a monitoring-flap combining with massive bone allograft

目的 探讨复合骨移植在下肢骨肿瘤保肢术中重建骨缺损的手术原理及效果. 方法应用携带监测皮岛吻合血管的自体腓骨与深低温冷冻大段同种异体骨复合移植,重建下肢骨肿瘤切除后的长段骨缺损12例.其中,骨肉瘤6例,恶性纤维组织细胞瘤1例,骨纤维结构不良2例,骨巨细胞瘤3例. 结果 12例经术后8～38个月随访,1例死于肺转移,2例带瘤存活,9例无瘤存活.术后功能优良率达75%.10例术后3个月内X线示骨端骨性愈合,2例内固定失败重新外固定后骨性愈合,所有均在9个月内能完全负重行走. 结论携带监测皮岛吻合血管的自体腓骨与深低温冷冻大段同种异体骨复合移植,适用于下肢骨肿瘤保肢术中的长段骨缺损的修复,具有自体活骨移植和异体骨移植的双重优点。