Allograft Reconstruction After Sarcoma Resection in Children Younger Than 10 Years Old

Múscolo, D. Luis; Ayerza, Miguel A.; Aponte-Tinao, Luis A.; Farfalli, Germán L.

doi:10.1007/s11999-008-0303-7

Cited by 66 publications

(47 citation statements)

References 30 publications

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“…The reported results in young children are very limited. Muscolo et al [8] reported the largest series of bulk allografts in patients aged 10 years or younger. Unfortunately, only one of the 22 reported cases was an osteoarticular proximal humerus.…”

Section: Introductionmentioning

confidence: 99%

Is Claviculo Pro Humeri of Value for Limb Salvage of Pediatric Proximal Humerus Sarcomas?

Calvert

Wright

Agarwal

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background There are several options for proximal humerus reconstruction in young children after resection of a malignant tumor and no one technique has been definitively shown to be superior to others, leaving the decision to surgeon and patient choice. Claviculo pro humeri (CPH) is a biologic reconstruction of the proximal humerus using the patient's ipsilateral clavicle as a rotational osseous flap. CPH represents a potential option for this complicated clinical problem in very young children, but little is known about it because the indications for its use are so uncommon. Questions/purposes The purposes of this study were to (1) assess the oncologic outcomes of CPH at a minimum of 2 years in a small series of patients; (2) elicit the complications associated with this procedure; and (3) show the Musculoskeletal Tumor Society (MSTS) functional score of these patients. Methods Four patients (average age, 5 years 11 months; range, 4 years 5 months to 8 years 9 months at the time of surgery) were treated with CPH for reconstruction after resection of a proximal humerus sarcoma; this represented all of the patients treated with this approach for this problem between January 2008 and April 2011 at one institution. During this period, the general indications for using CPH were the need to reconstruct a proximal humerus defect in a child younger than 10 years of age. During this time, CPH was used for all patients treated for proximal humerus sarcomas meeting these criteria. Patient demographics, diagnosis, tumor size and extent, operative details, radiographs and MRIs, complications, and functional outcomes were assessed. Results All are alive with no evidence of disease at a minimum followup of 31 months (average, 43 months; range, 31-58 months). Two patients developed nonunion and underwent revision surgery. Osseous union and a stable neoshoulder articulation were ultimately obtained in all patients. Limited shoulder motion was the only functional deficit noted with forward elevation ranging between 30°a nd 90°. MSTS functional scores were excellent with a range of 87% to 90%.

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Section: Introductionmentioning

confidence: 99%

Is Claviculo Pro Humeri of Value for Limb Salvage of Pediatric Proximal Humerus Sarcomas?

Calvert

Wright

Agarwal

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…It was hard to treat because of relapse of osteomyelitis, but repeated curettage with local and systemic antibiotics and also adjuvant hyperbaric oxygen has finally given a good result. Our results show that there are more difficulties in the limb saving treatment of patients under eight years of age [12,13,16]. It was hard to achieve the loading in the device with the youngest child; he had the most limited motion and the greatest shortening.…”

Section: Discussionmentioning

confidence: 75%

Epiphysis preserving resection of malignant proximal tibial tumours

Kiss

Treuer

Szabó

et al. 2012

International Orthopaedics (SICOT)

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Purpose The purpose of the study was to evaluate the treatment of five patients with proximal tibial epiphysis preserving resection for malignant tumours of the tibia. Method Three patients suffered from Ewing sarcoma, two had osteosarcoma. The proximal level of the resection was in the line of the growth plate in four patients, and 2 cm below of the growth plate in one patient. The distal resection level was in the diaphysis, depending on the tumour border. The resected part of the tibia was substituted by both the ipsilateral and contralateral fibulas. The two fibulas were proximally built into the epiphysis, the contralateral, freely transplanted fibula was placed distally into the tibial diaphysis. The leg was fixed in an Ilizarov frame. Results The follow-up period was 4.9 years on average (range, 3.5-8 years). Neither local recurrence nor metastasis was noticed in patients with tibia tumour resection during the observation time. Proper fixation of the transplanted fibula with all of the patients, both proximal to the tibia epiphysis and distal to diaphysis, was experienced. The range of motion of the knee was 122°on the average. Two patients can walk without support and three can walk with an orthosis fully weight bearing. The limb shortening of the affected side was 2.6 cm on average (range,1.5-4.5 cm). In three patients the transplanted opposite side fibula has broken. In one patient, chronic osteomyelitis developed at the distal part of the transplanted fibula. Conclusions The difficulties of intercalary segment supplementation were present to a greater extent because of the small size of proximal epiphysis, but the preserved knee joint can produce better function for the patient in this limb-saving surgery.

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“…The rate of retention of the original reconstruction observed in our study is greater than the previously reported rates for the use of allografts alone in the pediatric population. Muscolo and colleagues [32] noted a 95% rate of limb salvage; however, only 68% of patients had their original allograft reconstruction. Likewise, Campanacci and colleagues [9] reported 76% of pediatric patients had retained their original limb salvage reconstruction at last followup.…”

Section: Discussionmentioning

confidence: 99%

“…In oncological processes near the epiphysis and articular surface, a physeal-sparing procedure allows for the maintenance of the articular surface and epiphysis depending on the location of the tumor and that is typically not achievable with endoprostheses or osteoarticular allografts [15]. In selected patients, intercalary allograft reconstruction can be performed in combination with partial epiphyseal preservation; however, this is associated with a high complication rate [32,34]. The preservation of the articular cartilage is thought to provide joint stability, longevity of the joint, and, if the growth plate can be preserved and not hampered by fixation devices, limb growth may be unimpeded [34].…”

Section: Discussionmentioning

confidence: 99%

What Is the Outcome of Allograft and Intramedullary Free Fibula (Capanna Technique) in Pediatric and Adolescent Patients With Bone Tumors?

Houdek

Wagner

Stans

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background After bone tumor resection, reconstruction for limb salvage surgery can be challenging because of the resultant large segmental bony defects. Structural allografts have been used to fill these voids; however, this technique is associated with high complication rates. To circumvent the complications associated with this procedure, massive bony allografts have been supplemented with an intramedullary vascularized free fibula. However, few studies have examined the outcomes using this technique in the pediatric and adolescent populations. Questions/purposes The purpose of this study was to examine the revision-free survival using he Capanna technique for limb salvage for pediatric lower limb salvage. We attempted to answer the following questions: (1) What was the overall limb salvage rate along with incidence of reoperation and complications? (2) How did pediatric and adolescent patients functionally perform after this technique? (3) What was the incidence of late complications including infection and fracture? (4) What was the incidence of limb length discrepancy? Methods Eighteen pediatric patients who underwent lower extremity limb salvage with the use of cadaveric allograft and intramedullary free fibular transfer (Capanna technique) were identified. There were nine boys males and nine girls with a mean age of 11 years (range, 5-18 years) and mean followup of 8 years (range, 2-15 years), respectively. All patients had at least 2 years followup. Three patients have not been seen in followup during the past 5-years; however, all had made it to their 5-year clinical followup. The patients' medical records were reviewed for clinical and functional outcomes as well as postoperative complications. Time to union was recorded through an evaluation of radiographs. Mankin functional outcome and Musculoskeletal Tumor Society (MSTS) rating scale were recorded for each patient. Results The overall limb salvage rate was 94%. Fourteen patients underwent an additional surgical procedure. Six patients underwent additional procedure(s) to treat a symptomatic nonunion. Seventeen of the patients had a good or excellent Mankin score with a mean MSTS rating of 93% at last followup. Six of the patients underwent a limb length modification procedure. Conclusions Use of large allografts in conjunction with intramedullary vascularized free fibulas appears to be a reliable method for the reconstruction of large bony tumors of the lower extremity in this population, although we did not directly compare this with allografts alone in our study. The use of locked plates may improve union times. The proportion of patients achieving limb preservation was high and complication rates are acceptable. Level of Evidence Level IV, therapeutic study.

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Allograft Reconstruction After Sarcoma Resection in Children Younger Than 10 Years Old

Abstract: Level IV, therapeutic study.

Cited by 66 publications

References 30 publications

Is Claviculo Pro Humeri of Value for Limb Salvage of Pediatric Proximal Humerus Sarcomas?

Is Claviculo Pro Humeri of Value for Limb Salvage of Pediatric Proximal Humerus Sarcomas?

Epiphysis preserving resection of malignant proximal tibial tumours

What Is the Outcome of Allograft and Intramedullary Free Fibula (Capanna Technique) in Pediatric and Adolescent Patients With Bone Tumors?

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