Extracorporeally-Irradiated Autograft for the Reconstruction of Massive Bone and Joint Defects after Resection of Malignant Tumor: The New Technique to Reduce the Rate of Complication

Introduction: Recently, the new technique of extracorporeally-irradiated bone autograft for the reconstruction of massive bone and joint defects after resection of malignant tumor has been reported. However, because irradiated bone graft was necrotic bone, serious problems remain including non-union, infection and fracture. Vascularized bone grafting (VBG) has been established as a safe and reliable procedure to reconstruct segmental can be expected to provide vascularity and mechanical stability at the recipient-graft junction. We report here the clinical outcomes including radiographic findings, functional analyses and complications, as well as a discussion of the advantages and indication of this approach.

Methodology and Material: We reviewed 15 patients (9 men, 6 females, mean age 33 years old) who had undergone curative resection for malignant musculoskeletal tumor and 10 patients reconstructed with VBG and extracorporeally-irradiated autograft in combination, 5 patients reconstructed with only extracorporeally-irradiated autograft. The tumor location was the proximal humerus in two, shaft of ulna in two, acetabular in two, femur in three, shaft of tibia in six. 11 were used for intercalary graft and 4 were for osteochondral graft. The average size of defects after resection was 15cm (12-18); the size of VBG was 18cm (9-25). The average follow up time after surgery was 59 weeks.

Results: 14 cases are none evidence of disease, 1 case is dead of disease. Complications were non-union in 2, necrosis of free flap in one. One case had late infection but healed only with administration of antibiotics. The ulna case occurred bone resorption, but other cases showed bone-union within 10 month. MTS score of the shaft of tibia group is raging from 87 to 100%, mean % is 94.

Conclusions: Extracorporeally-irradiated bone autograft was a useful tool for the reconstruction of massive bone and joint defects after tumor resection. We used irradiated bone graft and VBG in combination. Each procedure covers another disadvantage by the own advantage. The roles of VBG used in our 10 patients are 1), to support the mechanical strength of the irradiated bone graft, 2), to achieve early bony union, and 3) to enhance neo-vascularization to the avascular graft.