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Can vascularized fibular grafts with pasteurized resected bone grafts have a positive impact on the treatment of femoral tumors?

Jun Nishida, Hideo Shiraishi, Goro Tajima, Shigeru Ehara, Tadash Shimamura

Med Sci Tech 2013; 54:7-15

DOI: 10.12659/MST.883784


Background: Because of a high rate of complications such as fractures and infections with pasteurized bone grafts, we began using a combination of pasteurized resected bone graft with vascularized fibular transfers. However, it is unclear whether this more complex approach reduces complications. We evaluated the oncologic results, union, functional scores, and postoperative complications after combination procedures of pasteurized bone graft and vascularized fibular graft.
Material and Methods: We retrospectively reviewed 8 patients (1 female and 7 males) who had received vascularized fibular grafts in combination with intercalary pasteurized resected grafts to reconstruct massive bone defects after excising femoral sarcomas. The mean age of the patients was 33.5 years (range, 11–61 years). We used the onlay technique to treat fractures of a previously implanted intercalary pasteurized resected bone grafts in 3 patients and to reconstruct primary bone defects with pasteurized intercalary grafts in the other 5 patients. At follow-up we determined Musculoskeletal Tumor Society (MSTS) functional score, union, incidence of recurrence and metastasis, patient survival, and complications. The minimum follow-up was 2.5 years (average, 8 years; range, 2.5–10.8 years).
Results: At the final follow-up, for the 5 patients who had undergone the combination procedure, all 10 graft junctions had union, and the other 3 patients who had pasteurized bone graft fractures each had 1 junction with complete bone union. The average postoperative MSTS functional score was 90%. No patient had a recurrence; 2 patients died of metastatic lung disease.
Conclusions: A vascularized fibular transfer combined with an intercalary pasteurized recycled bone graft appears to be a useful alternative method for use in reconstructing femoral defects after tumor resection.

Keywords: vascularized fibular graft, pasteurized autograft, bone sarcoma, Femur

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