The Use of Massive Allograft with Intramedullary Fibular Graft for Intercalary Reconstruction after Resection of Tibial Malignancy

Abstract

Reconstruction after intercalary excision of tibia malignancy is challenging. The combined use of a vascularized fibular flap and allograft can provide a reliable reconstructive option. Eight patients underwent reconstruction with an allograft and vascularized fibula following tibia malignancy resection. Patients were examined clinically and radiographically. The average age of patients was 16.5 years. The mean follow-up time was 38.4 months. Contralateral free fibula flap was used in three patients and ipsilateral pedicle fibula in five. The average length of defect was 11.8 cm and of fibula flap was 15.9 cm. Primary union was achieved in seven patients. The average time for bone union was 5.8 months at fibula-tibia junction and 14.1 months at allograft-tibia junction. Five patients had 10 complications. The Musculoskeletal Tumor Society average score was 90.8% at final follow-up. Intramedullary fibular flap in combination with massive allografts provide an excellent option for reconstruction of large bony defects after tibial malignancy extirpation. Ipsilateral pedicle fibula transportation had the advantages of short operation time and avoidance of donor site complications compared with the contralateral free fibula transfer.

Does Microwave Ablation of the Tumor Edge Allow for Joint-sparing Surgery in Patients With Osteosarcoma of the Proximal Tibia?

“…After tumor removal, massive allograft in combination with an ipsilateral transferred pedicled fibular graft was used for reconstruction (Fig. 5), which was described in a previous study [18].…”

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

“…Allograft fracture is a recognized complication that occurs after the use of massive bone allografts in up to 20% of patients [5,8,30,35,36,40]. Because the free fibular grafts provide an intrinsic blood supply, bony union can occur through the process similar to normal fracture healing [14,16,24,38,42]. Although fractures were common in our series, the intramedullary free fibula allowed the fractures to heal with ORIF or nonoperatively, which could not occur in an allograft alone.…”

“…Current options for limb salvage surgery include large cortical allografts, endoprostheses, distraction osteogenesis, and vascularized fibular graft [3,9,20,24,34,35]. Massive structural allografts have been most frequently used for limb reconstruction; however, complications such as allograft infection and fracture are common as a result of the avascular nature of the graft [24]. The Capanna technique was developed to add biology to the avascular graft to help reduce these complications [12]; however, reports of the use of the Capanna technique in the pediatric and adolescent populations are limited [31].…”

“…To provide the patient with an adequate oncological margin during the tumor resection, large osseous defects can be created that hamper functional limb salvage. Traditionally, structural allografts have been used to fill these defects, providing structural support using cortical bone; however, they are associated with a high complication rate as a result of the avascular nature of the allograft [5,11,13,24,25,27,31].…”

Vascularized fibular graft combined with vacuum assisted closure in the reconstruction of tibial defects

“…Non-vascularized bone auto-graft and allograft are adopted to reconstruct defects less than 5cm while vascularized fibular grafts are the most common treatment for necrotic tibial defects greater than 5cm（Brigman et al The grafting fibula was constantly thickening with new bone creeping along it -the thickening parts were cortical bone, the tibial defects were finally replaced by grafting fibula (Chen et al, 2014; Tanaka et al, 2012). However, the grafting fibula would not grow indefinitely and the maximum value of the diameter was no more than the tibia (Li et al 2011). The grafting fibula grew slowly for the patients more than 18 years old and we concluded that age was an important factor influencing the growth of grafting fibula.…”