Abstract
Introduction
We analyzed the results of extracorporeal radiated (ECRT) autogenous tumour bone for reconstruction of diaphyseal defects after tumour resection at our institute.
Methods
Sixteen diaphyseal bone tumours operated between March 2006 to March 2008 were reconstructed with ECRT bone after appropriate oncologic resection. These included 10 cases of Ewing's sarcoma, 5 of Osteosarcoma and 1 Adamantinoma. Nine involved femur, 5 tibia and 2 humerus. Suitable internal stabilisation (14 cases plate fixation, 2 intramedullary nails) was used after re-implanting ECRT bone. Average resection length was 18.9 cm (range, 11 to 30 cm).
Results
There were 32 osteotomy sites in 16 patients. 4 cases with infection resulting in graft removal were excluded. Thus 23 osteotomy sites (one patient had a bipolar prosthesis inserted into re-implanted bone) were analysed for union. The average union time was 6.8 months. 12 metaphyseal sites united at average 6 months and 11 diaphyseal ends at average 7.8 months. 2 cases developed hypertrophic nonunion (both at diaphyseal sites) requiring revision and bone grafting.
Reconstruction related complication were seen in 7(43%) out of 16 patients. Infection in 4 cases (25%), required multiple lavages, debridement and ultimately removal of the graft in all. The average follow up was 33 months (range, 27 to 45 months). There were 3 local recurrences (2 bony, 1 soft tissue), none of them in re-implanted bone. Four patients died of metastatic disease and 1 due to unrelated causes. At time of final review all survivors except one were capable of independent ambulation with an average MSTS Score of 26 (range, 18 – 29).
Conclusion
Extracorporeal irradiation is an oncologically sound procedure with good functional outcomes. It is a convenient and inexpensive technique for limb salvage avoiding the logistic issues involved in allograft procurement and specialized expertise for microvascular anastomosis.
