Free Vascularized Fibular Graft Reconstruction of Large Skeletal Defects after Tumor Resection

Eward, William C.; Kontogeorgakos, Vasileios; Levin, L. Scott; Brigman, Brian E.

doi:10.1007/s11999-009-1053-x

Cited by 85 publications

(80 citation statements)

References 27 publications

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“…compared with infection rates reported in allograft use (16-30%). 2,9,13,17) In our series, 3 patients (20%) experienced infections. Infection is only the reason for allograft removal except for local recurrence.…”

Section: Discussionmentioning

confidence: 49%

“…On last follow-up, the functional scores were acceptable (76%, 93%) and hypertrophied fibula seemed to have increasing bony mass up to a remodelling level, which can be considered as the outcome of its reactive hypertrophy. 13,31) Compared to other reconstructive options, the use of allograft and VFBG showed superior outcome especially in skeletal immaturity as in LLD. 22,23) Although rate of complication occurrence in allograft transplantation is high, published results for allografts show success rates of 66% to 84%.…”

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confidence: 99%

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How to Overcome Complications of Allograft Transplantation?

Cho

Choi

Kwon

et al. 2011

J Korean Bone Joint Tumor Soc

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IntroductionAllograft reconstruction is one of the functional reconstructive options, as a biologic reconstructive alternative to the bone defect in limb salvage surgery.1-3) However, allograft transplantation after malignant bone tumor and aggressive benign bone tumor have shown a high rate of complications.2) Mankin et al reported the complications of allograft in 870 massive frozen cadevaric allografts over a long term.2) During the first 3 years complications including fracture (19%), nonunion (17%) and infection (11%) before achieving stability with their grafts.2) Many other authors reported similar results concerning complication after allograft reconstruction. 3-9)The most common causes of graft failure are limited incorpora- that the use of autologous bone marrow mononuclear cell has a role in the re-building of large segmental defects. Original Article 11)The purpose of this study was to evaluate the complications of reconstruction after a bone tumor resection for the period of eventfree survival, and allograft survival as well as to elucidate how to prevent and overcome these complications based on our experiences and the literatures that have been reviewed. 대한골관절종양학회지：제17권 제2호 2011Purpose: We evaluated the complications of allograft reconstruction after a bone tumor resection, and reviewed literatures to overcome such complications. Materials and Methods:We retrospectively reviewed clinical records and radiographs of fifteen patients in whom reconstruction with allograft after bone tumor resection.Results: Eight patients were men and seven were women with a mean age of 27.1 years (1-56 years) and a mean follow-up period of 89.5 months (33-165 months). All postoperative complications related to the allograft were recorded. Twenty patients (80.0%) obtained a radiologic bony union at a mean of 8.35 months (4-12 months). The mean Musculoskeletal Tumor Society score was 73.5% (46.6-93.0%). Nine patients (60.0%) experienced one event and 3 (20.0%) patients experienced multiple events during the follow-up period. Recorded events were infection (3), fracture (2), nonunion (2), limb length discrepancy (2) and varus deformity (2). The mean event free survival period was 60.8 months (6-144 months). The mean allograft survival period was 80.2 months and the 5 year survival rate of the allografts was 83.0%. Conclusion:In order to overcome complications, the combination of an allograft and vascularized fibular graft is highly recommended. In the near future, the tissue engineering technique, the application of the stem cell and PRP, could reduce the complication of allograft such as resorption and nonunion.

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Section: Discussionmentioning

confidence: 49%

mentioning

confidence: 99%

How to Overcome Complications of Allograft Transplantation?

Cho

Choi

Kwon

et al. 2011

J Korean Bone Joint Tumor Soc

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“…16 Prevalence of infection varies between 7.5% and 13% after a segmental allograft [15][16][17][18] and 10% to 15% after a vascularized fibula. [19][20][21][22] No infections were noted in our series. The rationale for a low infection rate with the induced membrane technique includes the relatively short operative time, a simple and quick bone harvest, and the use of antibiotic-impregnated cement spacer.…”

Section: Discussionmentioning

confidence: 98%

Intercalary Segmental Reconstruction of Long Bones After Malignant Bone Tumor Resection Using Primary Methyl Methacrylate Cement Spacer Interposition and Secondary Bone Grafting

Villemagne

Bonnard

Accadbled

et al. 2011

Journal of Pediatric Orthopaedics

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“…These patients often have poor-quality, poorly vascularised, scarred-down, immobile tissues, and a single-stage osteocutaneous, osteomuscular or osteomusculocutaneous FVFG reconstruction may be preferable (for both the surgeon and the patient) if one can successfully secure a microvascular anastomosis. In cases of osteomyelitis, tumors and even higher-energy trauma, appropriate blood vessels may not be available for a microsurgical tissue transfer [32][33][34][35][36][37][38][39][40], and an arteriovenous (AV) fistula may be required to improve the success of any microvascular anastomosis [6].…”

Section: Fvfg In Trauma Infection and Tumormentioning

confidence: 99%

“…These aggressive tumors often cause significant intercalary bony destruction, and reconstruction of the residual defects is necessary following their radical excision [32][33][34][35][36][37][38][39][40]. Larger defects can be bridged with large/massive allografts, endoprostheses, bone-transport osteogenesis techniques and the use of nonvascularised bone grafts.…”

Section: Fvfg In Trauma Infection and Tumormentioning

confidence: 99%

Free vascularised fibular grafts in orthopaedics

Bumbaširević

Stevanović

Bumbaširević

et al. 2014

International Orthopaedics (SICOT)

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Bony defects caused by trauma, tumors, infection or congenital anomalies can present a significant surgical challenge. Free vascularised fibular bone grafts (FVFGs) have proven to be extremely effective in managing larger defects (longer than 6 cm) where other conventional grafts have failed. FVFGs also have a role in the treatment of avascular necrosis (AVN) of the femoral head, failed spinal fusions and complex arthrodeses. Due to the fact that they have their own blood supply, FVFGs are effective even in cases where there is poor vascularity at the recipient site, such as in infection and following radiotherapy. This article discusses the versatility of the FVFG and its successful application to a variety of different pathologies. It also covers the applied anatomy, indications, operative techniques, complications and donor-site morbidity. Though technically challenging and demanding, the FVFG is an extremely useful salvage option and can facilitate limb reconstruction in the most complex of cases.

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Free Vascularized Fibular Graft Reconstruction of Large Skeletal Defects after Tumor Resection

Abstract: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Cited by 85 publications

References 27 publications

How to Overcome Complications of Allograft Transplantation?

How to Overcome Complications of Allograft Transplantation?

Intercalary Segmental Reconstruction of Long Bones After Malignant Bone Tumor Resection Using Primary Methyl Methacrylate Cement Spacer Interposition and Secondary Bone Grafting

Free vascularised fibular grafts in orthopaedics

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