The aim of this study was to assess outcomes of biological (nonvascularized fibula grafts and extracorporeal irradiated autologous bone grafts) methods used for reconstruction of intercalary defects after resection of femoral diaphyseal tumors. Materials and Methods: This study included 28 patients who had undergone intercalary resection in femoral diaphyseal tumors between 2011 and 2016. The mean follow-up period was 24 months (range 12-57 months). Results: The mean union time for diaphyseo-diaphyseal union was 10.5 and 11 months in nonvascularized fibula group and extracorporeal radiotherapy (ECRT) group, respectively. The mean union time for metaphyseo-diaphyseal union was 6.5 months in both nonvascularized fibula and ECRT groups. Six patients had distant metastasis, and one patient had local recurrence. The mean Musculoskeletal Tumor Society score was 28 at the last follow-up. Two patients had surgical site infection in the nonvascularized fibula group. Implant failure was found in one patient of the ECRT group requiring revision surgery. Three patients had nonunion (two from the nonvascularized fibula group and one from the ECRT group). Conclusion: The present study indicates that the biological reconstruction modalities provide good functional outcomes in diaphyseal tumors of femur. Nonvasularized fibula and ECRT-treated autografts reconstruction provides good results, and union timing is comparable. The outcomes of the current study are promising as compared to the results in the reviewed literature. The reconstruction method depends on the resources available at the oncological center and the conversance with the method of the treating surgeon.

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Background Management of complex wounds of the lower extremity with concomitant Achilles tendon injury is a challenging situation for orthopaedic surgeons and plastic surgeons. The objective of the current study was to evaluate the clinical outcome of chronic open defects of the Achilles tendon with composite tissue loss. We have performed single stage reconstruction using the central segment of the proximal part of the Achilles tendon as turn-down flap and was covered immediately with reverse sural flap. Materials and methods Between March 2017 and February 2020, five cases of chronic open composite Achilles tendon defects which were treated by a single stage reconstruction method of "Repair and Flap technique" were included in this study. The patient with the defect for more than 4 weeks duration and had substance loss of Achilles tendon together with loss of overlying skin and soft tissue was included the current study. Results All the flaps survived and healed well, providing stable coverage of the wound. The mean operative duration, including flap elevation, definitive flap inset and donor-site coverage was 98 min (range 90-120 min). Focal areas of skin graft loss were seen in two patients which healed with conservative management. The functional results evaluation was performed with The Achilles Tendon Total Rupture Score (ATRS). The mean Achilles Tendon Total Rupture Score (ATRS) was 70 (range 65-76) Conclusion To conclude, use of proximal turned down flap and coverage with reverse sural flap can be opted as a first option for the management of chronic open wounds with composite defects of the Achilles tendon. "Repair and Flap technique" will be a useful method of reconstruction in centres with limited resources for microsurgical flap. However, a multicenter study with more number of patients are required to further analyse this method. KeywordsRepair and flap technique • Reverse sural flap • Achilles tendon • Chronic open wounds • Composite defect

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