The use of the vascularizedosteoseptocutaneous fibula transplant for extremity tumor reconstruction

Vascularized fibula graft for the traumatically induced long-bone defect

Long-bone defects resulting from trauma can be managed with a variety of techniques, including conventional bone grafting, distraction osteogenesis, bone graft substitutes, prosthetic devices, and vascularized bone grafting. Although there is an array of available methods for long-bone reconstruction of bony defects, vascularized bone transfer is particularly useful in large defects (> 6 cm) and in cases in which osteomyelitis and unstable soft-tissue or beds make conventional techniques difficult.

Functional and clinical outcomes of limb-sparing therapy for pediatric extremity sarcomas

PURPOSE

To determine the clinical and functional outcomes of children undergoing limb-sparing therapy for extremity sarcomas.

METHODS AND MATERIALS

We retrospectively reviewed 30 patients, age < or = 21 years, who were treated between l979 and l998 with external beam radiotherapy as a component of limb-sparing therapy for primary sarcomas of the extremity at UCSF. Included were patients for whom complete follow-up and functional outcome assessments were available. We assessed the patterns of failure, overall survival, disease-free survival, local control, and limb function.

RESULTS

At a median follow-up of 3 years, 12 of the 30 patients recurred: 3 locally, 8 distantly, and 1 with synchronous local and distant disease as site of first progression. Eighteen patients were alive with no evidence of disease. The median overall survival was 10 years, with a median disease-free survival of 8 years. Functional outcome assessment revealed 15 patients retained excellent, 12 good, 1 fair, and 2 poor limb function.

CONCLUSION

In pediatric patients receiving limb-sparing therapy, 90% maintained excellent or good limb function without compromising survival, demonstrating the validity of limb preservation in children with extremity sarcomas.

Microvascular reconstruction of the lower extremity

Microvascular reconstruction has revolutionized the care of the lower extremity oncology patient. Radical limb-sparing surgeries may now be performed with the reconstructive option of unlimited transfer of tissues from elsewhere in the body. In its infancy, free tissue transfer provided vascularized tissue for wound closure. Experience with microsurgery and creative thinking have now combined to address limb function and aesthetics. In oncologic surgery, limb salvage of a functional lower extremity is currently the rule, not the exception. Semin. Surg. Oncol. 19:272-281, 2000.