Technique and Results after Immediate Orthotopic Replantation of Extracorporeally Irradiated Tumor Bone Autografts with and without Fibular Augmentation in Extremity Tumors

Abstract

Background: the reconstruction of the bone defects after the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of an autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. Methods and patients: we were able to include 21 patients with 22 reconstructions. In all cases, the bone tumor was resected with wide margins and irradiated with 300 Gy. The autograft was orthotopically replanted and stabilized by means of osteosynthesis implants. 15 patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a local pedicled fibular interposition. Results: the most common diagnosis was a Ewing-sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months. During follow-up, 59% of patients underwent an average of 2.54 revision surgeries, with the most common reason being pseudarthrosis (6 cases). Complete bony integration of the irradiated autografts was achieved in 81.8% of cases after 13.6 months on average. In case of successful reintegration the autograft was shorter (n.s.). Fibular augmentation with or without microvascular anastomosis/pedicled blood supply did not correlate with the pseudarthrosis rate.Conclusions: the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors maintainable joints. However, these patients should be ready to accept longer treatment periods.