Biological Reconstruction for Extremity Osteosarcoma: Pasteurized Autogenous Bone Graft



Fig. 14.1
Form of bone graft. (a) Osteoarticular graft, (b) composite graft, (c) intercalary graft, (d) inlay graft, (e) pelvic graft




 


(d)

Fixation method: With an inlay graft, the graft bed is surrounded by fresh autogenous bone, and since the stability of the graft is good, fixation with only a screw is usually sufficient. An intercalary graft is prone to pseudarthrosis, so it is important to fix a strong bone junction and use an intramedullary nail and/or a double plate. In particular, at the junction of long bones, if there is an abundance of fresh cancellous bone, bone union is expected to be readily achieved. Therefore, in some cases, an autogenous bone graft should also be used at the junction.

 

(e)

Adjunct therapy: The bed of the pasteurized bone may have poor blood flow after tumor resection because of loss of soft tissue. Alternately, not only the tumor in the pasteurized bone but also the bone tissue itself may have been devitalized, resulting in poor bone union and susceptibility to infection. For this reason, and in the hope of preventing infection and achieving early resumption of blood flow to the bone, it may be necessary to also use a cover consisting of a muscle flap or musculocutaneous flap having good blood flow, or a vascularized autogenous bone graft.

 





14.3.2 Clinical Results with Pasteurized Bones



14.3.2.1 Subjects


We have previously applied the pasteurization method for bone grafting to 32 patients with primary malignant tumors of bones between 1989 and 2014. From these patients, the subjects of this study were those who had been followed up for at least 1 year and those who were excluded because of complications within less than 1 year. In two patients, follow-up was discontinued at less than 1 year because of local recurrence, but they were excluded because the cause of recurrence was aside from the pasteurized bone. Four other patients died less than 1 year after the surgery and were excluded. As a result, 26 patients were excluded. The median duration of follow-up was 106.5 months (Table 14.1).


Table 14.1
Summary of patient data, form of graft, and result of functional evaluation of pasteurized bone



























































































































































































































































No.

Age

Diagnosis

Affected bone

Size of graft (cm)

Form of graft

Fixation

Autobone graft

Complication

Additional surgery

Period to union (month)

Radiographic evaluation of resorption

1

10

EWING

Femur

23.5

Osteoarticular

Intramedullary nail with cement

(–)

Infection, pseudarthrosis, resorption

TFR
 
Poor

2

16

EWING

Humerus

11

Osteoarticular

Plate and intramedullary nail with cement

Iliac bone

Pseudarthrosis

(–)
 
Poor

3

28

EWING

Humerus

19

Osteoarticular

Intramedullary nail with cement

Pedicled scapula and iliac bone

(–)

(–)

13

Poor

4

17

OS

Humerus

17

Osteoarticular

Intramedullary nail with cement

(–)

Infection, pseudarthrosis

Debri and LD flap
 
Poor

5

28

OS

Tibia

24

Osteoarticular

Intramedullary nail with cement

Iliac bone

Infection

Amputation

8

Fair

6

12

OS

Tibia

12

Osteoarticular

Intramedullary nail

Iliac bone

Infection, resorption
 
7

Poor

7

18

EWING

Humerus

14

Osteoarticular -> composite

Intramedullary nail with cement

Iliac bone

Resorption

Humeral head prosthesis

15

Poor

8

11

OS

Tibia

12.5

Osteoarticular -> composite

Intramedullary nail with cement

Iliac bone

Joint instability, resorption

TKR

4

Poor

9

11

OS

Femur

18

Osteoarticular -> composite

Intramedullary nail with cement

Iliac bone

Pseudarthrosis, infection

TKR -> amputation

6 m after 2nd op. with autobone graft

Good

10

13

OS

Femur

20

Osteoarticular -> composite

Intramedullary nail with cement

Iliac bone

Pseudarthrosis, joint instability, loosening

TKR->TFR

13 m after 2nd op. with autobone graft

Poor

11

61

LYMPHOMA

Femur

25

Composite

Femoral head prosthesis with cement fixation and plate

Iliac bone

Infection

Removal of prosthesis

12

Good

12

14

OS

Femur

16

Composite

TKA prosthesis with cement fixation

(–)

Pseudarthrosis, loosening

Rotation plasty
 
Poor

13

11

OS

Femur

4

Composite

TKA prosthesis without cement fixation and plate

(–)

(–)

(–)

12

Good

14

24

Paro.OS

Femur

10

Composite

TKA prosthesis with cement fixation

Femoral local bone

(–)

(–)

7

Fair

15

34

OS

Femur

6

Intercalary

Intramedullary nail

FVFG and iliac bone

Pseudarthrosis

Autobone graft

7

Fair

16

17

OS

Tibia

15

Intercalary

Intramedullary nail and plate

Iliac bone

Fracture, pseudarthrosis

Autobone graft and plate

6 m after 2nd op. with autobone graft

Good

17

5

OS

Femur

18

Intercalary

Plate

FVFG

Pseudarthrosis, resorption

Turnup plasty
 
Poor

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Jun 4, 2017 | Posted by in ORTHOPEDIC | Comments Off on Biological Reconstruction for Extremity Osteosarcoma: Pasteurized Autogenous Bone Graft

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