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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.
J Surg Oncol. 2010 Oct 01; 102(5):368-74.JS

Abstract

BACKGROUND

Reconstruction after excision of the femur and tibia malignancy is a challenging issue for the reconstructive surgeon. The combined use of a vascularized fibular flap and allograft can provide a reliable reconstructive option. This article describes the authors' experience with this technique for the treatment of large-segmental bone defects after intercalary resection of lower extremity malignancy.

METHODS

From 2003 to 2008, 11 patients that had intercalary resection of lower extremity malignancy underwent reconstruction with an allograft and vascularized fibular construct. Time to union was recorded through evaluation of plain radiographs. Patients were examined clinically and radiographically and were assessed functionally with MSTS score.

RESULT

The average age at time of operation was 18.5 years. The mean follow-up time was 34.1 months. The oncology result was continuous disease free in 7 patients, no evidence of disease in 2, alive with disease in 1, and died of disease in 1. Free vascularized fibula flap was used in 7 patients and ispilateral pedicle vascularized fibula in 4. The average length of the resected segment was 12.1 cm and that of the fibula flap was 16.2 cm. The primary unions were achieved in all patients except one with tibia reconstruction. The average time for bone union was 5.4 months at fibula-host junction and 11.8 months at allograft-host junction. There were no allograft fractures and no infections. Five patients had 7 local complications. The MSTS average score was 91.8% at final follow-up. The mean time of weight-bearing was 12.4 months.

CONCLUSIONS

Intramedullary fibular flap in combination with massive allografts provide an excellent option for reconstruction of large-bony defects after lower extremity malignancy extirpation. The viability of the fibula is a cornerstone in success of reconstruction that prevents allograft nonunion and result in decreased time to bone healing, leading to earlier patient recovery and return of function.

Authors+Show Affiliations

Orthopaedic Oncology Department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an, PR China. ljfmmu@sina.com.cnNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20872944

Citation

Li, Jing, et al. "The Use of Allograft Shell With Intramedullary Vascularized Fibula Graft for Intercalary Reconstruction After Diaphyseal Resection for Lower Extremity Bony Malignancy." Journal of Surgical Oncology, vol. 102, no. 5, 2010, pp. 368-74.
Li J, Wang Z, Guo Z, et al. The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy. J Surg Oncol. 2010;102(5):368-74.
Li, J., Wang, Z., Guo, Z., Chen, G. J., Fu, J., & Pei, G. X. (2010). The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy. Journal of Surgical Oncology, 102(5), 368-74. https://doi.org/10.1002/jso.21620
Li J, et al. The Use of Allograft Shell With Intramedullary Vascularized Fibula Graft for Intercalary Reconstruction After Diaphyseal Resection for Lower Extremity Bony Malignancy. J Surg Oncol. 2010 Oct 1;102(5):368-74. PubMed PMID: 20872944.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy. AU - Li,Jing, AU - Wang,Zhen, AU - Guo,Zheng, AU - Chen,Guo-Jing, AU - Fu,Jun, AU - Pei,Guo-Xian, PY - 2010/9/28/entrez PY - 2010/9/28/pubmed PY - 2010/10/19/medline SP - 368 EP - 74 JF - Journal of surgical oncology JO - J Surg Oncol VL - 102 IS - 5 N2 - BACKGROUND: Reconstruction after excision of the femur and tibia malignancy is a challenging issue for the reconstructive surgeon. The combined use of a vascularized fibular flap and allograft can provide a reliable reconstructive option. This article describes the authors' experience with this technique for the treatment of large-segmental bone defects after intercalary resection of lower extremity malignancy. METHODS: From 2003 to 2008, 11 patients that had intercalary resection of lower extremity malignancy underwent reconstruction with an allograft and vascularized fibular construct. Time to union was recorded through evaluation of plain radiographs. Patients were examined clinically and radiographically and were assessed functionally with MSTS score. RESULT: The average age at time of operation was 18.5 years. The mean follow-up time was 34.1 months. The oncology result was continuous disease free in 7 patients, no evidence of disease in 2, alive with disease in 1, and died of disease in 1. Free vascularized fibula flap was used in 7 patients and ispilateral pedicle vascularized fibula in 4. The average length of the resected segment was 12.1 cm and that of the fibula flap was 16.2 cm. The primary unions were achieved in all patients except one with tibia reconstruction. The average time for bone union was 5.4 months at fibula-host junction and 11.8 months at allograft-host junction. There were no allograft fractures and no infections. Five patients had 7 local complications. The MSTS average score was 91.8% at final follow-up. The mean time of weight-bearing was 12.4 months. CONCLUSIONS: Intramedullary fibular flap in combination with massive allografts provide an excellent option for reconstruction of large-bony defects after lower extremity malignancy extirpation. The viability of the fibula is a cornerstone in success of reconstruction that prevents allograft nonunion and result in decreased time to bone healing, leading to earlier patient recovery and return of function. SN - 1096-9098 UR - https://www.unboundmedicine.com/medline/citation/20872944/The_use_of_allograft_shell_with_intramedullary_vascularized_fibula_graft_for_intercalary_reconstruction_after_diaphyseal_resection_for_lower_extremity_bony_malignancy_ L2 - https://doi.org/10.1002/jso.21620 DB - PRIME DP - Unbound Medicine ER -