Segmental Femur Reconstruction Using an Intercalary Allograft with an Intramedullary Vascularized Fibula Bone Flap

The use of intercalary allografts has been an important innovation for use in limb-salvage surgery. However, the principal disadvantage of intercalary allografts is a high incidence of nonunion, fracture, and infection. With a recent trend toward higher doses of chemotherapy, an increased incidence of nonunion and healing problems can be anticipated with the use of allografts.

In this article, the authors report two cases in which a vascularized fibula bone flap was used with an intercalary allograft, utilising an intramedullary approach, for immediate femur reconstruction following sarcoma resection. The rationale for this approach is to combine the mechanical strength of an allograft with the biologic activity of a vascularized bone flap. The allograft provides bone stock and early stability, while the addition of the vascularized bone flap substantially facilitates the host-allograft union.

Fibula flap - allograft - limb salvage

REFERENCES

• 1 Mankin H J, Gebhardt M C, Jenning L C, Springfield D S, Tomford W W. Long-term results of allograft replacement in the management of bone tumors.  Clin Orthop Relat Res. 1996;  324 86-97
• 2 Donati D, Di Liddo M, Zavatta M et al.. Masssive bone allograft reconstruction in high-grade osteosarcoma.  Clin Orthop. 2000;  377 186-194
• 3 Ortiz-Cruz E, Gebhardt M C, Jennings L C, Springfield D S, Mankin H J. The results of transplantation of intercalary allografts after resection of tumors.  J Bone Joint Surg. 1997;  79A 97-106
• 4 Hornicek F J, Gebhardt M C, Tomford W W et al.. Factors affecting nonunion of the allograft-host junction.  Clin Orthop. 2001;  382 87-98
• 5 Muscolo D L, Ayerza M A, Calabrese M E, Redal M A, Araujo E S. Human leukocyte antigen matching, radiographic score, and histologic findings in massive frozen bone allografts.  Clin Orthop. 1996;  326 115-126
• 6 Han C S, Wood M B, Bishop A T, Cooney W P. Vascularized bone transfer.  J Bone Joint Surg. 1992;  74A 1441-449
• 7 Satoh T, Tsuchiya M, Harii K. A vascularized iliac musculo-periosteal free flap transfer: a case report.  Jpn J Plast Surg. 1983;  36 109-112
• 8 Ng R HL, Sharma S K, Chang D W et al.. Vascularized bone transfers for the management of allograft non-union in cancer patients. Presented at the annual meeting of the American Society for Reconstructive Microsurgery, Cancun, Mexico January 2002
• 9 Hsu R WW, Wood M B, Sim F H, Chao E YS. Free vascularized fibular grafting for reconstruction after tumour resection.  J Bone Joint Surg. 1997;  79B 36-42
• 10 Ceruso M, Falcone C, Innocenti M, Delcroix L, Capanna R, Manfrini M. Skeletal reconstruction with a free vascularized fibula graft associated with bone allograft after resection of malignant bone tumor of limbs.  Handchir Mikrochir Plast Chir. 2001;  33 277-282
• 11 Taddei F, Viceconti M, Manfrini M, Toni A. Mechanical strength of a femoral reconstruction in paediatric oncology: a finite element study.  Proc Inst Mech Eng[H]. 217 111-119 2003; 
• 12 Enneking W F, Campanacci D A. Retrieved human allografts. A clinicopathological study.  J Bone Joint Surg. 2001;  83A 971-986