Summary
We review eight patients who underwent curative resection for malignant musculoskeletal
tumour followed by reconstruction with vascularised bone graft in combination with
extracorporeally-irradiated autograft. This method consists of (1) wide en-bloc resection
of the tumour; (2) curettage of tumour from the resected bone; (3) extracorporeal
irradiation with 60 to 70 Gy as a bolus single dose; (4) vascularised bone grafting from the fibula (six cases)
or scapula (two cases); (5) re-implantation of the irradiated bone into the recipient
and fixation with plates and screws. Five cases were located in the tibial shaft and
one each in the ulnar shaft, distal femur and acetabulum. Radiological and functional
outcomes were excellent in four patients who were reconstructed with vascularised
fibula and irradiated intercalary tibial bone graft. Two patients with irradiated
osteochondral graft showed osteoarthritic change in the long term. No local recurrences
arising from the irradiated bones were detected. Combination of a vascularised and
an extracorporeally-irradiated bone graft is a useful reconstructive tool for massive
bone defects arising from resection of malignant musculoskeletal tumour. This approach
has the advantage of combining the biological properties provided by the vascularised
bone graft with the mechanical endurance of the irradiated bone autograft. The method
is best indicated for intercalary defects of the tibia.
Keywords
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Article info
Publication history
Published online: May 11, 2007
Accepted:
March 27,
2007
Received:
June 23,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
