title: Vascularised or non-vascularised autologous fibular grafting for the reconstruction of a diaphyseal bone defect after resection of a musculoskeletal tumour.
abstract: Resection of a primary sarcoma of the diaphysis of a long bone creates a large defect. The biological options for reconstruction include the use of a vascularised and non-vascularised fibular autograft. The purpose of the present study was to compare these methods of reconstruction. Between 1985 and 2007, 53 patients (26 male and 27 female) underwent biological reconstruction of a diaphyseal defect after resection of a primary sarcoma. Their mean age was 20.7 years (3.6 to 62.4). Of these, 26 (49 %) had a vascularised and 27 (51 %) a non-vascularised fibular autograft. Either method could have been used for any patient in the study. The mean follow-up was 52 months (12 to 259). Oncological, surgical and functional outcome were evaluated. Kaplan-Meier analysis was performed for graft survival with major complication as the end point. At final follow-up, eight patients had died of disease. Primary union was achieved in 40 patients (75%); 22 (42%) with a vascularised fibular autograft and 18 (34%) a non-vascularised (p = 0.167). A total of 32 patients (60%) required revision surgery. Kaplan-Meier analysis revealed a mean survival without complication of 36 months (0.06 to 107.3, sd 9) for the vascularised group and 88 months (0.33 to 163.9, sd 16) for the non-vascularised group (p = 0.035). Both groups seem to be reliable biological methods of reconstructing a diaphyseal bone defect. Vascularised autografts require more revisions mainly due to problems with wound healing in distal sites of tumour, such as the foot.
authors.affiliation: Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Schuh
authors.affiliation: Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria.
authors.forename: J
authors.initials: J
authors.lastname: Panotopoulos
authors.affiliation: Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria.
authors.forename: S E
authors.initials: SE
authors.lastname: Puchner
authors.affiliation: Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Willegger
authors.affiliation: Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria.
authors.forename: G M
authors.initials: GM
authors.lastname: Hobusch
authors.affiliation: Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria.
authors.forename: R
authors.initials: R
authors.lastname: Windhager
authors.affiliation: Medical University of Vienna, Department of Orthopaedics, Waehringer Guertel 18 to 20, Vienna, 1090, Austria.
authors.forename: P T
authors.initials: PT
authors.lastname: Funovics
mesh_terms: D000293:Adolescent; D000328:Adult; D001859:Bone Neoplasms / Q000601:surgery*; D016025:Bone Transplantation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D018483:Diaphyses / Q000601:surgery; D005260:Female; D005360:Fibula / Q000098:blood supply / Q000637:transplantation*; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012509:Sarcoma / Q000601:surgery*; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
keywords: Bone defect; Musculoskeletal tumour; Non-vascularised autologous fibula graft; Vascularised