Free Vascularized Fibular Grafting For Malignant Bone and Soft Tissue Tumor: Ragiological, Clinical...
-
Upload
richard-jordan-brown -
Category
Documents
-
view
216 -
download
2
Transcript of Free Vascularized Fibular Grafting For Malignant Bone and Soft Tissue Tumor: Ragiological, Clinical...
Free Vascularized Fibular Grafting ForMalignant Bone and Soft Tissue Tumor:Ragiological , Clinical and Functional Outcome
Kaya M, Wada T, Nagoya S, Sasaki M, Matsumura T and Yamashita T
Dept. of Orthop. Surg. Sapporo Medical University
CTOS 14th Annual Meeting, November 15, 2008London, UK
Reconstructive options after bone and soft tissue tumor removal
•Tumor Megaprosthesis•Treated Bone pasteurized autologous bone
liquid nitrogen treated boneextracorponeal irradiated bone
•Allograft•Vascularized Fibula•Distractive osteogenesis
Reconstructive options after bone and soft tissue tumor removal
•Tumor Megaprosthesis•Treated Bone pasteurized autologous bone
liquid nitrogen treated boneextracorponeal irradiated bone
•Allograft•Vascularized Fibula•Distractive osteogenesis
Purpose
To analyze the clinical results of free vascularized fibula graft (FVFG) reconstruction after the removal of malignant bone and soft tissue tumor.
Indications
•Malignant bone tumor of distal femur and proximal tibia
•Possible to preserve of popleteal vessels and nerves
12 patients who were followed more than 5 years
were enrolled.
Follow up periods Ave. 95 months
Histology
OS 11 Pts.
MFH 1
Clinical Results
Limb sparing 83.3 % ( 10/12 Pts. )
skip metastasis 1 Pt
Infection 1
Union 83.3 %( 10/12 Pts. )
Time to the Union 6 Mo.
Pain Function Emotional External Walking Gait Total
acceptance support ability
100 97.2 87.5 100 95 60 86.3
MSTS functional score ( mean, %)
Biceps femoris tendon
Fibular head
Humerus
Peroneal a.
Commitant v.
Transient wire
Posterior circum. hemeral a. Basilic v.
J Bone Joint Surg Br, 1999
Reconstruction Methods
9 patients were reconstructed
with this methods
Follow up periods Ave. 95 months
Histology
OS 11 Pts.
CS 3
MFH 1
Case Age Histology Union FU Results( M )
1. 43 CS + 90 CDF2. 20 OS + 30 DOD3. 10 OS + 91 CDF4. 17 OS + 191 CDF5. 30 OS + 196 CDF6. 34 MFH + 164 CDF7. 14 OS + 150 CDF8. 47 CS + 32 CDF9. 20 CS + 12 CDF
Clinical Results
Complications
# of case# of case Additional TreatmentAdditional Treatment
•Fibula Head 55 NoneNone
Absorption
•Fracture Fracture 1 1 ORIF+bone graftORIF+bone graft
•Delayed Union Delayed Union 11 Bone graftBone graft
•InfectionInfection 1 1 DebridementDebridement
pain function emotion hand manual liftposition
dexiterityability
97.7 92.5 73.3 73.3 100 66.6
MSTS Functional Score (mean, %)
II
IIII
IIIIIIEnneking & DunhamEnneking & Dunham
Indications
•Malignant bone tumor
arised in pelvic bone
•Possible to preserve of femoral
vessels and sciatic nerve
6 patients were reconstructed
with this methods
Follow up periods Ave. 7.1 yrs. (0.7-12)
Histology
CS 3 pts.
OS 2
pleomorphic adenomapleomorphic adenoma 1
Clinical Results
# # Histology Histology Relapse Relapse GraftGraft FU(Y) FU(Y) MetastasisMetastasis RResultsesults
11 OSOS + + N/A N/A 0.7 0.7 lunglung DDOD OD
22 CSCS - - union union 12 12 - - CDF CDF
3 3 CSCS - - union union 12 12 - - CDF CDF
4 4 CSCS - - union union 11 11 - - CDF CDF
5 5 AdenoAdeno - - non-union 3.5non-union 3.5 - - CDF CDF
6 6 OSOS - - union 3.5union 3.5 lung,spinelung,spine DODDOD
Clinical Results
# # Histology Histology Relapse Relapse GraftGraft FU(Y) FU(Y) MetastasisMetastasis RResultsesults
11 OSOS + + N/A N/A 0.7 0.7 lunglung DDODOD
22 CSCS - - union union 12 12 - - CDF CDF
3 3 CSCS - - union union 12 12 - - CDF CDF
4 4 CSCS - - union union 11 11 - - CDF CDF
5 5 AdenoAdeno - - non-union 3.5non-union 3.5 - - CDF CDF
6 6 OSOS - - union 3.5union 3.5 lung,spinelung,spine DODDOD
Complications
# of case# of case additional treatmentadditional treatment
•InfectionInfection 22 debridement debridement
•fracture fracture 1 1 ORIFORIF
•Delayed union Delayed union 22 bone graftbone graft
•Wound troubleWound trouble 1 1 debridementdebridement
•Non unionNon union 22 ORIF+bone graftORIF+bone graft
MSTS functional evaluation
Case Pain Function Emotional External Walking Gait Total
acceptance support ability
1 N/A N/A N/A N/.A N/A N/AN/A
2 5 5 5 5 5 5 30
3 5 5 5 5 4 4 28
4 5 3 3 4 3 4 26
5 2 1 1 0 0 0 4
6 N/A N/A N/A N/.A N/A N/AN/A
MSTS functional evaluation
Case Pain Function Emotional External Walking Gait Total
acceptance support ability
1 N/A N/A N/A N/.A N/A N/AN/A
2 5 5 5 5 5 5 30
3 5 5 5 5 4 4 28
4 5 3 3 4 3 4 26
5 2 1 1 0 0 0 4
6 N/A N/A N/A N/.A N/A N/AN/A
Free Vascularized Fibula Graft
Advantage•Biological reconstruction•Durability
Disadvatage•Complicated methods•High risk of complication
Knee Athrodesis
•Long durability
•Excellent pain relief and support
•Poor in emotional acceptance and gait ability
•Social acceptance??
Golden standard = Tumor Megaprosthesis
Proximal humerus reconstruction
•Tumor Megaprosthesis•Clavicula Pro Humero Reconstruction•Sling Procedure
Proximal humerus reconstruction
•Tumor Megaprosthesis•Clavicula Pro Humero Reconstruction•Sling Procedure
•Biological spacer
•Even in case with glenoid resection
•Maximize the elbow and hand function
by reconstructing the mobile shoulder
Hip Arthrodesis
•Low grade tumor ; good indication for this procedure•High grade tumor; its use cannot be recommended•Good durability and function•Severe functional loss in case with non union or infection
Summary
•We evaluated the clinical results of FVFG reconstruction
•We evaluated advantage and disadvantage of this method
•Careful patients selection and accurate surgical technique determine the clinical results