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Lenze U, Krieg AH. [Treatment of pediatric bone tumors around the knee]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:659-666. [PMID: 39105771 DOI: 10.1007/s00132-024-04538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/07/2024]
Abstract
Primary bone tumors are rare but more frequently seen during childhood and with predilection for the distal femur and proximal tibia. Therapy of benign tumors-if indicated-includes surgical resection in most cases, whereas malignant bone tumors such as osteo- and Ewing's sarcomas are treated with chemotherapy, wide resection and/or radiation therapy (Ewing's sarcoma). The reconstruction of emerging bone defects is significantly influenced by surgeon-related preferences and tumor-associated factors, respectively. Double-barrel vascularized fibula grafts or extracorporeally irradiated autografts in combination with a free fibula transplant are preferred biological reconstruction techniques around the knee joint. In cases in which the knee joint cannot be preserved, reconstruction is performed using tumor endoprostheses, but potentially emerging leg length discrepancies after resection of a potent physis must be taken into account. In considerably young patients, rotationplasty might represent a viable option with promising functional results.
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Affiliation(s)
- Ulrich Lenze
- Klinik für Orthopädie und Sportorthopädie, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, München, Deutschland.
- ZEM - Germany, Zentrum für Extremitätenchirurgie München, Nymphenburger Straße 1, 80335, München, Deutschland.
| | - Andreas H Krieg
- Knochen und Weichteiltumorzentrum der Universität Basel (KWUB), Basel, Schweiz
- Abteilung für Kinderorthopädie, Universitäts-Kinderspital beider Basel (UKBB), Basel, Schweiz
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Sambri A, Zunarelli R, Morante L, Paganelli C, Parisi SC, Bortoli M, Montanari A, Fiore M, Scollo C, Bruschi A, De Paolis M. Graft Infections in Biologic Reconstructions in the Oncologic Setting: A Systematic Review of the Literature. J Clin Med 2024; 13:4656. [PMID: 39200798 PMCID: PMC11354657 DOI: 10.3390/jcm13164656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 08/03/2024] [Accepted: 08/06/2024] [Indexed: 09/02/2024] Open
Abstract
Background: Biologic graft infection (BGI) is one of the main complications in graft reconstructions. However, very little evidence exists regarding the epidemiology of BGI, as most of the data come from sparse reports. Moreover, most of the series did not detail the treatment and outcome of graft infections. The aim of this systematic review of the literature is to provide a comprehensive data collection on BGI after oncologic resections. Methods: Three different databases (PubMed, Scopus, and Web of Science) were searched for relevant articles, and further references were obtained by cross-referencing. Results: 139 studies met the inclusion criteria. A total of 9824 grafts were retrieved. Among these, 684 (6.9%) were in the humerus, 365 (3.7%) in the pelvis, 2041 (20.7%) in the femur and 1660 (16.8%) in the tibia. Most grafts were osteoarticular (2481, 26.7%) and intercalary 2112 (22.7%) allografts. In 461 (5.0%), vascularized fibula grafts (VFGs) were used in combination with recycled autografts. Recycled grafts were reported in 1573 (16.9%) of the cases, and allograft-prosthetic composites in 1673 (18.0%). The pelvis and the tibia had the highest incidence of BGI (20.4% and 11.0%, respectively). The most reported first treatment was debridement and implant retention (DAIR) in 187 (42.8%) cases and two-stage revision with graft removal in 152 (34.8%). Very little data are reported on the final outcome specified by site or type of graft. Conclusions: This systematic review of the literature confirms a high incidence of infections in biologic reconstructions after resections of primary bone tumors. Despite DAIR being a viable attempt, in most cases, a two-stage approach with graft removal and reconstruction with endoprosthesis presented the highest chance to overcome infection, guaranteeing a reconstruction. We emphasize the need for future multicentric studies to focus on the management of infections after biological reconstructions in bone sarcomas.
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Affiliation(s)
- Andrea Sambri
- Orthopedic and Traumatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (R.Z.); (L.M.); (C.P.); (S.C.P.); (M.B.); (A.M.); (M.F.); (C.S.); (A.B.); (M.D.P.)
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Luca D, Sara T, Marco I, Andrea CD. The use of vascularized fibula flap with allograft in post-oncologic microsurgical bone reconstruction of lower limbs in pediatric patients. Microsurgery 2024; 44:e31172. [PMID: 38651631 DOI: 10.1002/micr.31172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 01/26/2024] [Accepted: 03/07/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Post-oncologic surgical reconstruction of lower limbs in pediatrics remains a challenging topic. Microsurgical techniques allow reconstructions of large bony defects. The use of vascularized fibular flap with allograft has proven to be an ideal biologic construct. We aim to assess the success rate of this operation, including flap survival, bony union, weight-bearing ambulation, and complications in a long-term follow-up in our case series compared to the literature. PATIENTS AND METHODS Our case-series includes 18 femoral resections (9 osteosarcomas, 8 Ewing sarcoma, and 1 desmoid tumor) and 15 tibial resections (10 osteosarcoma, 4 Ewing sarcoma, and 1 Malignant Fibrous Histiocytoma). We collected patients' demographics, type of tumor, type of resection, defect size, fibula-flap length, method of fixation, anastomosis site, follow-up data, complications, and their management. All survivals were examined by X-ray and CT-scan to evaluate the morphological changes of the vascularized fibula and follow-up. The functional evaluation was performed by the 30-point Musculoskeletal Tumor Society Rating Score (MSTS) for the lower limb (Enneking et al., Clinical Orthopaedics and Related Research 1993(286):241-246). RESULTS The mean age of the femur resection patients' group was 11.2 years with a mean defect size of 14 cm and a mean length of the fibular flap of 18 cm; for the tibia the mean age was 12 years with a mean defect size of 14 cm and a mean length of the fibular flap of 16.6 cm. The overall survival of the reconstructions at 5 years follow-up was 17 out 18 cases for the femur and 13 out of 15 cases for the tibia. MSTS score was 28.2 for the femur and 23.7 for the tibia. The average time of union of the fibula was seen after 5 months, while allograft consolidation was observed around 19.7 months. The mean time of follow-up was 144.5 months for the femur and 139.2 months for the tibia. The complication rate observed was 7 out of 18 for the femur and 7 out of 15 for the tibia reconstructions. CONCLUSIONS The viability of the fibula is a cornerstone in the success of reconstruction as well as the successful management of complications in intercalary defects after tumor resection in pediatrics to restore good functionality. Our results are in line with those reported in the literature in terms of overall complication rates. The high primary union of allograft, the high MSTS score obtained, and the low rate of severe complications reflect the mechanical role of this reconstructive technique over a long follow-up.
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Affiliation(s)
- Delcroix Luca
- Department of Plastic Reconstructive and Microsurgery, AOU Careggi, Florence, Italy
| | - Tamburello Sara
- Department of Plastic Reconstructive and Microsurgery, AOU Careggi, Florence, Italy
- University of Florence, Florence, Italy
| | - Innocenti Marco
- IRCCS-Istituto ortopedico Rizzoli, Bologna, Italy, Bologna, Italy
- Dipartimento di Scienze Biomediche, Neuromotorie, Università di Bologna, Bologna, Italy
| | - Campanacci Domenico Andrea
- University of Florence, Florence, Italy
- Department of Oncologic Orthopedic Surgery, AOU Careggi, Florence, Italy
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Dong M, Gao Y, Fan H, Wang Y, Lv J, Bai J, Shao P, Gao Y, Lv Z, Feng Y. Comparison of clinical efficacy of 3D-printed artificial vertebral body and conventional titanium mesh cage in spinal reconstruction after total en bloc spondylectomy for spinal tumors: a systematic review and meta-analysis. Front Oncol 2024; 14:1327319. [PMID: 38380368 PMCID: PMC10878420 DOI: 10.3389/fonc.2024.1327319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
Propose This meta-analysis aimed to determine whether 3D-printed artificial vertebral bodies (AVBs) have superior clinical efficacy compared to conventional titanium mesh cages (TMCs) for spinal reconstruction after total en bloc spondylectomy (TES) for spinal tumors. Methods Electronic databases, including PubMed, OVID, ScienceDirect, Embase, CINAHL, Web of Science, Cochrane Library, WANFANG, and CNKI, were searched to identify clinical trials investigating 3D-printed AVB versus conventional TMC from inception to August 2023. Data on the operation time, intraoperative blood loss, preoperative and postoperative visual analogue scale (VAS) scores, preoperative and postoperative Frankel classification of spinal cord injury, vertebral body subsidence, and early complications were collected from eligible studies for a meta-analysis. Data were analyzed using Review Manager 5.4 and Stata 14.0. Results Nine studies assessing 374 patients were included. The results revealed significant differences between the 3D-printed AVB and conventional TMC groups with regard to operation time (P = 0.04), intraoperative blood loss (P = 0.004), postoperative VAS score (P = 0.02), vertebral body subsidence (P < 0.0001), and early complications (P = 0.02). Conversely, the remaining preoperative VAS score and Frankel classifications (pre-and postoperative) did not differ significantly between the groups. Conclusion The 3D-printed AVB in spinal reconstruction after TES for spinal tumors has the advantages of a short operative time, little intraoperative blood loss, weak postoperative pain, low occurrence of vertebral body subsidence and early complications, and a significant curative effect. This could provide a strong basis for physicians to make clinical decisions. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441521, identifier CRD42023441521.
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Affiliation(s)
- Mingjie Dong
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Yingjie Gao
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Hao Fan
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yushan Wang
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan, China
- Shanxi Key Laboratory of Bone and Soft Tissue Injury Repair, Taiyuan, China
| | - Jia Lv
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Junjun Bai
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Pengfei Shao
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yu Gao
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Zhi Lv
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yi Feng
- Department of Orthopaedics, the Second Hospital of Shanxi Medical University, Taiyuan, China
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Hovav O, Kolonko S, Zahir SF, Velli G, Chouhan P, Wagels M. Limb salvage surgery reconstructive techniques following long-bone lower limb oncological resection: a systematic review and meta-analysis. ANZ J Surg 2023; 93:2609-2620. [PMID: 36821561 DOI: 10.1111/ans.18335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Limb salvage surgery (LSS) is now considered the gold standard surgical treatment for lower limb bone sarcomas. However, there is a paucity of literature comparing the various LSS reconstructive options. The aim of this systematic review and meta-analysis was to compare functional outcomes and complications of LSS reconstructive techniques. METHODS The primary aim of the meta-analysis was to determine functional outcomes from the pooled data utilizing the Musculoskeletal Tumour Society score (MSTS). Comparisons could then made for this outcome between biological and prosthetic, vascularised and non-vascularised, and prosthetic and composite reconstructions. The secondary aim was to compare complication outcomes of each reconstruction. Standardized mean difference (Cohen's d) and odds ratios were estimated using a random effects model. RESULTS Fourteen studies with a total of 785 patients were included. We found structural failure was 75% less likely to occur in prosthetic reconstruction compared to biological (OR = 0.24; 95% CI: 0.07-0.79; P = 0.02). We did not find any evidence of difference in function (MSTS score) between vascularised verses non-vascularised reconstructions (Cohen's d = -1.14; 95% CI = -3.06 to 0.78; I2 = 87%). Other analyses comparing complications found no difference between the reconstructive groups. CONCLUSION The study found no correlation between functional outcomes and the type of LSS reconstruction. Structural failure was more likely to occur in biological when compared with prosthetic reconstruction. There was no correlation between the incidence of other complications and the type of LSS technique. This suggests a role for improved approaches to reconstruction methods including bioprinting and bioresorbable devices.
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Affiliation(s)
- Oliver Hovav
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- The Australian Centre for Complex Integrated Surgical Solutions, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
| | - Sarah Kolonko
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Syeda Farah Zahir
- Princess Alexandra Hospital Library and Knowledge Centre, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Gina Velli
- Department Plastic and Reconstructive Surgery, Sunshine Coast, Sunshine Coast University Hospital, Queensland, Australia
| | - Prem Chouhan
- School of Medicine, Griffith University, Southport, Queensland, Australia
- Department of Plastic Surgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Michael Wagels
- Department of Plastic and Reconstructive Surgery, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- The Australian Centre for Complex Integrated Surgical Solutions, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Brisbane, Queensland, Australia
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Xu H, Li Y, Yu F, Liu W, Hao L, Zhang Q, Niu X. GMRS Oncological Prosthesis with a Porous Coating Collar: A Good Option for Revision of Aseptic Loosening in the Lower Extremity. J Clin Med 2023; 12:jcm12030892. [PMID: 36769540 PMCID: PMC9918170 DOI: 10.3390/jcm12030892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/29/2022] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Revisions for oncological prosthesis are especially challenging due to the limited bone quantity and poor quality that the patients still possess. The aims of this study were to ask (1) what is the cumulative survival of the Global Modular Replacement System (GMRS) prosthesis after revision? and (2) what are the long-term functional outcomes of these patients? METHODS We retrospectively reviewed 16 patients who developed aseptic loosening of a lower extremity prosthesis. There were nine males and seven females with a mean age of 28 years (range, 14-55 years). The 5-year and 8-year survivorship of the prosthesis were calculated. Function outcome was evaluated according to the score of the Musculoskeletal Tumor Society (MSTS). RESULTS At a mean of 90 months follow-up (range, 52-118 months), the cumulative survival of all revision prosthesis was 94% at both 5 and 8 years. There were two prosthesis failures including one infection and one repeated aseptic loosening. At the last follow-up, except for the infection case, 93.3% (14/15) of the patients did not develop repeated aseptic loosening. The mean MSTS score was 27.7 (range, 24-30). CONCLUSIONS GMRS prosthesis demonstrated significant satisfactory long-term outcomes for revisions of lower extremity oncological prosthesis.
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Affiliation(s)
| | | | | | | | | | | | - Xiaohui Niu
- Correspondence: ; Tel.: +86-10-58516506; Fax: +86-10-58516736
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Yamamoto N, Araki Y, Tsuchiya H. Joint-preservation surgery for bone sarcoma in adolescents and young adults. Int J Clin Oncol 2023; 28:12-27. [PMID: 35347494 PMCID: PMC9823050 DOI: 10.1007/s10147-022-02154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 03/07/2022] [Indexed: 01/11/2023]
Abstract
Bone sarcoma often occurs in childhood, as well as in adolescents and young adults (AYAs). AYAs differ from pediatric patients in that their bone is skeletally mature and the physis has almost disappeared with the completion of growth. Although AYAs spend less time outside, they often participate in sports activities, as well as driving, working, and raising a family, which are natural activities in daily living. Multidisciplinary approaches involving imaging, multi-agent chemotherapy, surgical procedures, and careful postoperative care has facilitated an increase in limb-sparing surgery for bone sarcoma. In addition, recent advances in imaging modalities and surgical techniques enables joint-preservation surgery, preserving the adjacent epiphysis, for selected patients following the careful assessment of the tumor margins and precise tumor excision. An advantage of this type of surgery is that it retains the native function of the adjacent joint, which differs from joint-prosthesis replacement, and provides excellent limb function. Various reconstruction procedures are available for joint-preserving surgery, including allograft, vascularized fibula graft, distraction osteogenesis, and tumor-devitalized autografts. However, procedure-related complications may occur, including non-union, infection, fracture, and implant failure, and surgeons should fully understand the advantages and disadvantages of these procedures. The longevity of the normal limb function for natural activities and the curative treatment without debilitation from late toxicities should be considered as a treatment goal for AYA patients. This review discusses the concept of joint-preservation surgery, types of reconstruction procedures associated with joint-preservation surgery, and current treatment outcomes.
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Affiliation(s)
- Norio Yamamoto
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa-city, Ishikawa 920-8641 Japan
| | - Yoshihiro Araki
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa-city, Ishikawa 920-8641 Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa-city, Ishikawa 920-8641 Japan
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Bläsius F, Delbrück H, Hildebrand F, Hofmann UK. Surgical Treatment of Bone Sarcoma. Cancers (Basel) 2022; 14:cancers14112694. [PMID: 35681674 PMCID: PMC9179414 DOI: 10.3390/cancers14112694] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/22/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022] Open
Abstract
Bone sarcomas are rare primary malignant mesenchymal bone tumors. The three main entities are osteosarcoma, chondrosarcoma, and Ewing sarcoma. While prognosis has improved for affected patients over the past decades, bone sarcomas are still critical conditions that require an interdisciplinary diagnostic and therapeutic approach. While radiotherapy plays a role especially in Ewing sarcoma and chemotherapy in Ewing sarcoma and osteosarcoma, surgery remains the main pillar of treatment in all three entities. After complete tumor resection, the created bone defects need to be reconstructed. Possible strategies are implantation of allografts or autografts including vascularized bone grafts (e.g., of the fibula). Around the knee joint, rotationplasty can be performed or, as an alternative, the implantation of (expandable) megaprostheses can be performed. Challenges still associated with the implantation of foreign materials are aseptic loosening and infection. Future improvements may come with advances in 3D printing of individualized resection blades/implants, thus also securing safe tumor resection margins while at the same time shortening the required surgical time. Faster osseointegration and lower infection rates may possibly be achieved through more elaborate implant surface structures.
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Affiliation(s)
- Felix Bläsius
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany; (F.B.); (H.D.); (F.H.)
- Centre for Integrated Oncology Aachen Bonn Köln Düsseldorf (CIO), 52074 Aachen, Germany
| | - Heide Delbrück
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany; (F.B.); (H.D.); (F.H.)
- Centre for Integrated Oncology Aachen Bonn Köln Düsseldorf (CIO), 52074 Aachen, Germany
| | - Frank Hildebrand
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany; (F.B.); (H.D.); (F.H.)
- Centre for Integrated Oncology Aachen Bonn Köln Düsseldorf (CIO), 52074 Aachen, Germany
| | - Ulf Krister Hofmann
- Department of Orthopaedic, Trauma and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany; (F.B.); (H.D.); (F.H.)
- Centre for Integrated Oncology Aachen Bonn Köln Düsseldorf (CIO), 52074 Aachen, Germany
- Correspondence: ; Tel.: +49-(0)241-80-89350
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Wahyudi M, Satria O, Prawirodihardjo B, Zulhandani M. Periosteal osteosarcoma of the femur treated with modified capanna procedure: A case report. Int J Surg Case Rep 2021; 87:106414. [PMID: 34555680 PMCID: PMC8458975 DOI: 10.1016/j.ijscr.2021.106414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/11/2021] [Accepted: 09/12/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Periosteal osteosarcoma is a rare type of primary bone tumor. A vascularized fibula graft incorporates this revolutionary approach with a traditional massive allograft to reconstruct large femur and tibia defects during oncological resection. A structurally competent reconstruction with improved vascular and osteogenic capacities with the ability to achieve lower rates of fracture, infection, and non-union is obtained by integrating the benefits of this separate components. METHOD A 16-year-old female diagnosed with periosteal osteosarcoma of the left shaft femur. We performed neoadjuvant chemotherapy, limb salvage surgery consists of surgical resection and reconstruction, followed by adjuvant chemotherapy post operatively. We used the modified Capanna procedure to salvage the femur. RESULT Post-operative evaluation showed stable fixation clinically and radiologically. There were no complications observed during recovery, as both distal motor and sensory are normal eventhough the patient were still limited in the motion of the hip and knee at the time due to post-operative pain. DISCUSSION Cappana procedure has been known as a novel surgical method that could decrease the risk of complications results from classic reconstruction method, such as fracture, non-union, and infection. CONCLUSION Modified Cappana procedure which introduce the use liquid nitorgen-recycled autograft from the resected affected bone as a peripheral shell supporting a centrally placed vascularized fibular graft to fill the massive bone defect left by surgical resection, had successfully performed in our patient whom previously diagnosed with periosteal osteosarcoma of femoral shaft.
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Affiliation(s)
- Muhammad Wahyudi
- Orthopaedic Oncology Consultant, Department of Orthopaedic and Traumatology, Fatmawati General Hospital Jakarta, Indonesia
| | - Oryza Satria
- Hand and Microsurgery Consultant, Department of Orthopaedic and Traumatology, Fatmawati General Hospital Jakarta, Indonesia
| | - Bonita Prawirodihardjo
- Anatomic Pathologist, Department of Anatomical Pathology, Fatmawati General Hospital Jakarta, Indonesia
| | - Muhammad Zulhandani
- Orthopaedic and Traumatology Resident, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
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Variability in the reported surgical techniques and methods for intercalary reconstruction following tumor resection. Surg Oncol 2021; 38:101610. [PMID: 34091268 DOI: 10.1016/j.suronc.2021.101610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION There is currently no consensus regarding the best techniques or surgical strategies with which to maximize intercalary allograft reconstruction outcomes. The purpose of the current study was to assess which techniques and methods are being utilized by North American orthopaedic oncologists. METHODS Members of the Musculoskeletal Tumor Society (MSTS) were invited to complete an anonymous online questionnaire. The survey presented participants with two clinical scenarios and interrogated them on their preferred type of allograft, method of compression and fixation, and additional techniques used. RESULTS One hundred and twenty-six physicians completed the questionnaire. The majority studied in the United States (82%) and worked at an academic medical center (71%). Over half (54%) reported seeing over 10 primary bone tumors every year. Respondents were split between preferring a structural allograft alone or using a combined allograft-vascularized fibular graft. A majority indicated a preference for plate(s) and screw fixation but were divided between the use of two compression plates with a spanning plate, a single compression plate with a spanning plate, and two compression plates with an intramedullary nail. Screw fixation preferences were split between the use of unicortical locking only, bicortical locking only, and a combination of unicortical and bicortical locking. Almost equal percentages of respondents reported they would have used two, three, or four screws in both scenarios. Respondents were split between placing screws equidistantly and placing them peripherally within the allograft, adjacent to the allograft-host junction. DISCUSSION There is no clear surgical preference for intercalary reconstruction following tumor extirpation within this sample of orthopaedic oncologists. The current survey demonstrates variability across nearly every aspect of allograft reconstruction, which may, in part, explain the wide spectrum of outcomes reported within the literature. Prospective studies are warranted to better evaluate technique-specific outcomes in an effort to maximize reconstructive longevity and minimize allograft related complications.
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