title: Pedicle frozen autograft reconstruction in malignant bone tumors.
abstract: BACKGROUND
  Standardizing limb salvage surgery for malignant bone tumors should result in improved limb function after tumor excision and reconstruction. Recently, we developed and clinically applied a method of biological reconstruction using tumor-bearing autografts treated with liquid nitrogen. We report this newly modified technique using pedicle frozen autografts to save the continuity of anatomical structures.
  
  
  METHODS
  We treated 33 malignant bone tumor patients. Diagnoses of the tumors were 17 osteosarcomas, 11 metastatic tumors, 2 Ewing's sarcomas, 2 chondrosarcomas, and 1 undifferentiated pleomorphic sarcoma. The sites of the tumors were 23 femurs, 5 tibias, 4 humeri, and 1 calcaneus. Operative procedures consisted of exposing the tumor, performing one-site osteotomy or joint dislocation, rotating and freezing the tumor lesion in liquid nitrogen for 20 min, and reconstruction using intramedullary nailing, plates, or composite arthroplasty.
  
  
  RESULTS
  Postoperative function was excellent in 25 patients (75.7%), good in 5 patients (15.1%), and fair in 3 patients (9.0%). At the final follow-up, 8 patients had died at a mean of 17 months postoperatively, and 18 patients remained disease-free for a mean follow-up period of 30 months (range 7-69 months). Seven patients were alive but with disease. Complications were encountered in 12 patients, including 4 deep infections, 3 fractures, 3 local recurrences from surrounding soft tissue, 2 nonunions, and 1 collapse. All were managed successfully.
  
  
  CONCLUSIONS
  The pedicle frozen autograft, which was newly developed to solve drawbacks of previously reported free frozen autografts, achieved success for reconstruction of malignant bone tumors. This is a new, simple, effective surgical technique for biological reconstruction that is still investigated but has potential for development.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Tsuchiya
authors.forename: Hideji
authors.initials: H
authors.lastname: Nishida
authors.forename: Phutsapong
authors.initials: P
authors.lastname: Srisawat
authors.forename: Toshiharu
authors.initials: T
authors.lastname: Shirai
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Hayashi
authors.forename: Akihiko
authors.initials: A
authors.lastname: Takeuchi
authors.forename: Norio
authors.initials: N
authors.lastname: Yamamoto
authors.forename: Katsuro
authors.initials: K
authors.lastname: Tomita
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D005615:Freezing; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000601:surgery*; D010027:Osteotomy / Q000379:methods*; D013048:Specimen Handling / Q000379:methods*; D016019:Survival Analysis; D014182:Transplantation, Autologous / Q000379:methods; D055815:Young Adult