Akshay Tiwari1, Sandeep Mehta2, S K Sharma3, Vijaydeep Chauhan4, Himanshu Rohela1, Rajan Arora5. 1. Orthopedic Oncology Unit, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India. 2. Plastic and Reconstructive Surgery Unit, Department of Surgical Oncology, BLK Cancer Centre, New Delhi, India. 3. Department of Radiation Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India. 4. Department of Orthopedics, Ambedkar Hospital, New Delhi, India. 5. Plastic and Reconstructive Surgery unit, Department of Surgical Oncology, Rajiv Gandhi Cancer Institute, New Delhi, India.
Abstract
BACKGROUND: Reconstruction of segmental bone defects following resection of bone sarcomas is a challenging procedure. Vascularised fibula grafts alone or in combination with extracorporeal radiotherapy and reimplantation of tumor bone have long been established as a method of reconstruction of such defects, with satisfying results. Prompted by paucity of data on Indian patients, we report our experience with vascularised fibula graft for patients undergoing limb salvage surgery for sarcomas of bone. MATERIAL AND METHODS: A total of 25 patients underwent the procedure from December 2008 to December 2014. Femur was the commonest site and osteosarcoma was the commonest diagnosis. Intercalary resection was done in 19 patients and arthrodesis in 6 patients. Vascularised fibula was used in combination with extra corporeally irradiated bone in eight patients, and alone in 17 patients. RESULTS: All but one limb could be salvaged, and all but three patients had united at final follow up. Combination of extracorporeal radiotherapy and reimplantation with vascularised fibula fared better than vascularised fibula alone in terms of time to union (9.6 months vs 12.2 months) and rate of graft related complications (14.2% vs 62.5%). CONCLUSION: Reconstruction with VFG with or without ECRT has a good and predictable functional outcome. Though manageable with active intervention, complications were more commonly seen with vascularised fibula alone than a combination of the two techniques.
BACKGROUND: Reconstruction of segmental bone defects following resection of bone sarcomas is a challenging procedure. Vascularised fibula grafts alone or in combination with extracorporeal radiotherapy and reimplantation of tumor bone have long been established as a method of reconstruction of such defects, with satisfying results. Prompted by paucity of data on Indian patients, we report our experience with vascularised fibula graft for patients undergoing limb salvage surgery for sarcomas of bone. MATERIAL AND METHODS: A total of 25 patients underwent the procedure from December 2008 to December 2014. Femur was the commonest site and osteosarcoma was the commonest diagnosis. Intercalary resection was done in 19 patients and arthrodesis in 6 patients. Vascularised fibula was used in combination with extra corporeally irradiated bone in eight patients, and alone in 17 patients. RESULTS: All but one limb could be salvaged, and all but three patients had united at final follow up. Combination of extracorporeal radiotherapy and reimplantation with vascularised fibula fared better than vascularised fibula alone in terms of time to union (9.6 months vs 12.2 months) and rate of graft related complications (14.2% vs 62.5%). CONCLUSION: Reconstruction with VFG with or without ECRT has a good and predictable functional outcome. Though manageable with active intervention, complications were more commonly seen with vascularised fibula alone than a combination of the two techniques.
Entities:
Keywords:
Indian patients; Limb salvage surgery; Vascularised fibula
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