Use of allografts following resection of tumors of the musculoskeletal system.

Allografts are an effective method of reconstructing defects following the resection of benign or malignant tumors. The surgeon must carefully plan the procedure in two stages. Stage I involves resection of the tumor with an adequate margin to prevent local recurrence, and stage II involves reconstruction of the limb with a durable and functional technique that has a low risk of morbidity. Allograft reconstructions are technically demanding. The prerequisites to a successful reconstruction include rigid internal fixation of the allograft, competent soft tissues to cover the graft, preoperative and postoperative antibiotic coverage, meticulous hemostasis and postoperative wound drainage to prevent hematoma formation, and protection of the allograft to allow union. Whenever soft-tissue coverage of the graft is in question, local rotational flaps or free microvascular transfers should be used to cover the allograft with healthy muscle. Second surgical procedures, such as revision of necrotic soft-tissue flaps, drainage of hematomas, bone grafting of nonunions, and revision of internal fixation, should be avoided by careful technique at the index operation because additional procedures place the allograft at risk for infection. Further basic science investigations and clinical studies should expand the applications of allograft reconstructions and lower the incidence of complications.