THE HALIFAX EXPERIENCE OF MASSIVE ALLOGRAFTS WITH VASCULARISED FIBULAS IN SARCOMA LIMB SALVAGE SURGERY

Abstract

Purpose: To describe our experience with vascularised fibulas used in sarcoma limb salvage surgery using standardized patient outcome measures.

Methods: All vascularised fibulas and osteochondral allografts performed in the Capital District Health authority were assessed. A complete chart review and current functional assessment of the patients using the Toronto Extremity Salvage score (TESS) and the Musculosketal Tumour Society (MSTS) score were performed.

Results: Nineteen patients with 19 tumors were recorded. The tumors range from 11 osteosarcomas, 4 Ewing’s sarcoma, 3 Malignant Fibrous Histiocytoma’s and 1 Chondrosarcoma. Average age was 23. The patient demographics are 75% male, 42% smokers, 86% femoral lesions and 13 % presented with pathological fracture. There were 9 hip fusions, 3 knee fusions, 6 intercalary grafts and one osteochondral graft. There was 21 % mortality with 21% lung mets, 20% local recurrence, 15.7% rates of amputation or infection or and non union. Allograft fracture rates of 10% were noted. Two patients underwent numerous operations (18) due to non-compliance. Rate of surgical failures defined as patients requiring re-operation after 2 years is 21%. Of 19 patients 10 are working, 4 are unable and 4 are deceased and 1 lost to follow up. Average follow up is 9.8 years (range of 4–18). Our functional results include TESS averaging 57.5 with a range of 30–105 and MSTS scores of average of 16.8 with a range of 3–28 and a percent score average of 55.8. The average score on the subjective assessment question was 4 equaling a response of accept it and would do it again. The Halifax outcome and functional data corresponds well with that in the literature.

Conclusions: The biological repair of a combination of large Allografts with Vascularised Fibula’s is an excellent long term solution for construct survival with unrestricted patient activity.