Biological reconstruction using massive bone allograft with intramedullary vascularized fibular flap after intercalary resection of humeral malignancy

Li, Jing; Wang, Zhen; Pei, Guoxian; Guo, Zheng

doi:10.1002/jso.21922

Cited by 30 publications

(37 citation statements)

References 52 publications

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“…The complication rate in the intercalary group (53%) was lower than in the other groups—albeit not statistically significant ( P = 0.622). Li et al found a comparable complication rate of 43% in intercalary allograft and vascularized fibula construct, with no fractures. Likewise, Aponte‐Tinao et al found no fractures in their intercalary group either and concluded that intercalary allograft had the lowest complication rate and best mean function score compared to osteoarticular allografts and APC.…”

Section: Discussionmentioning

confidence: 95%

Allograft reconstruction of the humerus: Complications and revision surgery

Teunissen

Massier

Raskin

et al. 2018

Journal of Surgical Oncology

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Background and Objectives Allograft reconstruction of the humerus after resection is preferred by many because of bone stock restoration and biologic attachment of ligaments and muscles to the allograft, theoretically obtaining superior stability and functionality. Our aim was to assess the prevalence of complications and the incidence and etiology for revision surgery in humeral allograft reconstructions. Methods We included patients 18 years and older who underwent wide resection and allograft reconstruction of the humerus for primary and metastatic lesions at our institution between 1990 and 2013. Our primary outcome measures were complications and revision surgery. We used competing risk regression to assess allograft survival. Results Of the 84 patients we included, 47 patients (51%) underwent allograft reconstructions of the proximal humerus, 30 (36%) intercalary, and seven (8%) of the distal humerus. Fifty‐one patients (61%) had at least one complication after surgery. Eighteen patients (21%) underwent revision surgery. The 5‐year allograft survival was 71%. Conclusion Although allograft reconstructions of the humerus are a valuable option in the orthopedic oncologist's armamentarium, surgeons should mind the accompanying complication rates. Allograft fractures seem to be the main issue for proximal and distal allografts, often leading to revision surgery. Intercalary allografts are mostly troubled by nonunions.

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Section: Discussionmentioning

confidence: 95%

Allograft reconstruction of the humerus: Complications and revision surgery

Teunissen

Massier

Raskin

et al. 2018

Journal of Surgical Oncology

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“…The devitalized bone graft provides bone stock and initial mechanical stability, and VFG substantially not only promotes bone union of the host‐graft junction, but also enhances neo‐vascularization to the dead, grafted bone, which provides osteoblastic and osteoclastic progenitor cells . Li et al noted that the healing process between VFG and the host bone occurred in a fashion identical to that seen in normal fracture healing, without creeping substitution . In addition, a recent study demonstrated that the additional use of VFG enhanced histological repair in heat‐treated autografts as assessed by histological examination .…”

Section: Discussionmentioning

confidence: 99%

Predictors of complications in heat‐treated autograft reconstruction after intercalary resection for malignant musculoskeletal tumors of the extremity

Ikuta

Nishida

Sugiura

et al. 2018

Journal of Surgical Oncology

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“…Li et al [16] observed that abundant callus originated from the outlayer of the fibula that union the fibula with the host bone and allograft together. Pasteurized autogenous bones are similar to allografts, in that both possess bone induction ability and bone conductive ability [14].…”

Section: Discussionmentioning

confidence: 99%

Treatment and outcome of malignant bone tumors of the proximal humerus: biological versus endoprosthetic reconstruction

Liu

Zhang

Guo

et al. 2014

BMC Musculoskelet Disord

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BackgroundThe purpose of this study was to compare the outcome, complications and survival of the commonly used surgical reconstructions of the proximal humerus after intrarticular tumour resection in our hospital.MethodsBetween 1998 and 2010, 41 consecutive proximal humeral reconstructions using prosthesis (group P, n = 25) or recycled pasteurized autograft combined with non-vascularised fibula autograft (group B, n = 16) were performed.ResultsThe mean follow-up was 57.7 months. Fourteen patients (8 patients in group P and 6 in group B) died during the follow-up period, the disease-specific survival of patients in group P was 74.5% at 5 years and in group B was 67.0%. Local recurrences were occurred in 3 cases (12.0%) in group P and 2 (12.5%) in group B. Pulmonary metastases were observed in 4 patients (16.0%) in group P and 4 (25.0%) in group B. There was no significant difference in the incidence of local recurrence, pulmonary metastasis or death of disease. Revisions were indicated in 9 patients (36.0%) in group P and 5 (31.25%) in group B. Thought the incidence of revisions was higher in group P, there was no significant difference in these two groups. The Kaplan-Meier 5-year implant survival estimates, with revision for any reason as the end point, were 80.6% and 68.8% for group P and group B, respectively. The mean MSTS Score was 63.6% in group P and 63.0% in group B. These differences were not statistically significant.ConclusionsThe study could show that prosthetic reconstruction and reconstruction with recycled pasteurized autograft are similar in terms of their local recurrence and metastasis, while the incidence of revisions was higher for patients with prosthetic reconstruction.

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Biological reconstruction using massive bone allograft with intramedullary vascularized fibular flap after intercalary resection of humeral malignancy

Cited by 30 publications

References 52 publications

Allograft reconstruction of the humerus: Complications and revision surgery

Allograft reconstruction of the humerus: Complications and revision surgery

Predictors of complications in heat‐treated autograft reconstruction after intercalary resection for malignant musculoskeletal tumors of the extremity

Treatment and outcome of malignant bone tumors of the proximal humerus: biological versus endoprosthetic reconstruction

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