scholarly journals Technique and Results after Immediate Orthotopic Replantation of Extracorporeally Irradiated Tumor Bone Autografts with and without Fibular Augmentation in Extremity Tumors

2021 ◽  
Author(s):  
Alexander Klein ◽  
Yasmin Bakhshai ◽  
Falk Roeder ◽  
Christof Birkenmaier ◽  
Andrea Baur-Melnyk ◽  
...  
Keyword(s):  
Bone Tumors ◽  
Tumor Resection ◽  
Clinical Results ◽  
Bone Defects ◽  
Fibular Graft ◽  
Microvascular Anastomosis ◽  
Common Location ◽  
Common Diagnosis ◽  
Bone Autograft

Abstract Background: the reconstruction of the bone defects after the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of an autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. Methods and patients: we were able to include 21 patients with 22 reconstructions. In all cases, the bone tumor was resected with wide margins and irradiated with 300 Gy. The autograft was orthotopically replanted and stabilized by means of osteosynthesis implants. 15 patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a local pedicled fibular interposition. Results: the most common diagnosis was a Ewing-sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months. During follow-up, 59% of patients underwent an average of 2.54 revision surgeries, with the most common reason being pseudarthrosis (6 cases). Complete bony integration of the irradiated autografts was achieved in 81.8% of cases after 13.6 months on average. In case of successful reintegration the autograft was shorter (n.s.). Fibular augmentation with or without microvascular anastomosis/pedicled blood supply did not correlate with the pseudarthrosis rate.Conclusions: the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors maintainable joints. However, these patients should be ready to accept longer treatment periods.

scholarly journals Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Alexander Klein ◽  
Yasmin Bakhshai ◽  
Falk Roeder ◽  
Christof Birkenmaier ◽  
Andrea Baur-Melnyk ◽  
...  
Keyword(s):  
Bone Tumors ◽  
Tumor Resection ◽  
Clinical Results ◽  
Fibular Graft ◽  
Microvascular Anastomosis ◽  
First Case ◽  
Common Location ◽  
Skeletal Defects ◽  
Common Diagnosis

Abstract Background Reconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of a vital autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation. Methods Twenty-one patients with 22 reconstructions were included. In all cases, the bone tumor was resected with wide margins and in 21 of them irradiated with 300 Gy. In the first case, thermal sterilization in an autoclave was used. The autograft was orthotopically replanted and stabilized with plates and screws. Fifteen patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a locally pedicled fibular interposition. Results the most common diagnosis was a Ewing sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months (16–154 months). For our statistical analysis, the one case with autoclave sterilization and 3 patients with tumors in small bones were excluded. During follow-up of 18 cases, 55.6% of patients underwent an average of 1.56 revision surgeries. Complete bony integration of the irradiated autografts was achieved in 88.9% of cases after 13.6 months on average. In those cases with successful reintegration, the autograft was shorter (n.s.). Microvascular anastomosis in vascularized fibular strut grafts did not significantly influence the rate of pseudarthrosis. Conclusions the replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors that allow for joint preservation. However, these patients should be ready to accept longer treatment periods.

scholarly journals Free Vascularized Fibular Graft With LISS Plate for the Bone Defects of the Femur After Tumor Resection

Hand ◽  
2016 ◽  
Vol 11 (1_suppl) ◽  
pp. 73S-73S
Author(s):  
Young Ho Lee ◽  
Jihyeung Kim ◽  
Seung Hoo Lee ◽  
Jin Woo Park ◽  
Kahyun Kim ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Bone Defects ◽  
Fibular Graft ◽  
Vascularized Fibular Graft ◽  
Free Vascularized Fibular Graft

scholarly journals Pediatric Mandibular Resection and Reconstruction: Long-Term Results with Autogenous Rib Grafts

2010 ◽  
Vol 3 (1) ◽  
pp. 25-32 ◽  
Author(s):  
André M. Eckardt ◽  
Enno-Ludwig Barth ◽  
Johannes Berten ◽  
Nils-Claudius Gellrich
Keyword(s):  
Tumor Resection ◽  
Three Dimensional ◽  
Bone Defects ◽  
Long Term Results ◽  
Benign Tumors ◽  
Tumor Surgery ◽  
Bone Augmentation ◽  
Facial Skeleton ◽  
Computed Tomographic

Reconstruction of mandibular defects following tumor resection in infants is a particular challenge. Although autogenous rib grafts have no relevance in the restoration of mandibular bone defects occurring after ablative tumor surgery due to limited bone stock and the availability of other donor areas, they are a useful surgical alternative following tumor surgery in infants. We here report on a 2, 5, 8, and 15-year follow-up of four children who were diagnosed with benign tumors of the mandible with osseous destruction at the age of 4, 6, 15, and 18 months, respectively. Histologic diagnoses were melanotic neuroectodermal tumor ( n=2), hemangioendothelioma of the mandible ( n=1), and ameloblastoma ( n=1). Following continuity resection of the mandible, lateromandibular bone defects were restored using autogenous rib grafts. Both clinical and radiologic follow-up visits were performed for all children to assess growth of the facial skeleton and the mandible. One child was already further reconstructed using bone augmentation at the age of 15 years. Cephalometric measurements on panorex films and three-dimensional computed tomographic scans revealed a slight vertical growth excess and transversal growth inhibition of the reconstructed mandible compared with the nonoperated side. Although further growth of rib grafts is difficult to predict and occlusal disharmony may occur due to physiologic maxillary growth and growth of the unaffected mandible, we believe that autogenous rib grafts can be ideally used for the restoration of mandibular continuity defects in newborns and young children. Clinical follow-up visits on a yearly basis and orthodontic controls are useful for early orthodontic treatment of growth deficits. Further corrective surgery with bone augmentation or osseous distraction is required following completion of growth of the facial skeleton.

scholarly journals Long-term follow-up of fibular graft for the reconstruction of bone defects

Medicine ◽  
2018 ◽  
Vol 97 (40) ◽  
pp. e12605 ◽  
Author(s):  
Siyi Liu ◽  
Shengxiang Tao ◽  
Jinhai Tan ◽  
Xiang Hu ◽  
Huiyi Liu ◽  
...  
Keyword(s):  
Bone Defects ◽  
Fibular Graft ◽  
Long Term Follow Up ◽  
Reconstruction Of Bone Defects

scholarly journals Iliosacral Bone Tumor Resection Using Cannulated Screw-Guided Gigli Saw - A Novel Technique

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Tao Ji ◽  
Brian Z. J. Chin ◽  
Xiaodong Tang ◽  
Rongli Yang ◽  
Wei Guo
Keyword(s):  
Local Recurrence ◽  
Tumor Resection ◽  
Surgical Margins ◽  
Osteotomy Site ◽  
R0 Resection ◽  
Primary Tumors ◽  
Current Series ◽  
Common Diagnosis ◽  
Sacral Foramina

Abstract Background Adequate margins are technically difficult to achieve for malignant tumors involving the sacroiliac joint due to limited accessibility and viewing window. In order to address the technical difficulties faced in iliosacral tumor resection, we proposed a technique for precise osteotomy, which involved the use of canulated screws and Gigli saw (CSGS) that facilitated directional control, anteroposterior linkage of resection points and adequate surgical margins. The purpose of the current study was to evaluate whether CSGS technique facilitated sagittal osteotomy at sacral side, and were adequate surgical margins achieved? Also functional and oncological outcomes was determined along with the noteworthy complications. Methods From April 2018 to November 2019, we retrospectively reviewed 15 patients who underwent resections for primary tumors of pelvis or sacrum necessitating iliosacral joint removal using the proposed CSGS technique. Chondrosarcoma was the most common diagnosis. The osteotomy site within sacrum was at ipsilateral ventral sacral foramina in 8 cases, midline of sacrum in 5 cases, and contralateral ventral sacral foramina and sacral ala with 1 case each. The average intraoperative blood loss was 3640 mL (range, 1200 and 6000 mL) with a mean operation duration of 7.4 hours (range, 5 to 12 hours). The mean follow-up was 23.0 months (range, 18 and 39 months) for alive patients. Results Surgical margins were wide in 12 patients (80%), wide-contaminated in 1 patient (6.7%), and marginal in 2 patients (13.3%). R0 resection was achieved in 12 (80%) patients and R1 resection in 3 patients. There were three local recurrences (20%) occurred at a mean time of 11 months postoperatively. No local recurrence was observed at sacral osteotomy. The overall one-year and three-year survival rate was 86.7% and 72.7% respectively.Complications occurred in three patients. Conclusions The current study demonstrated that CSGS technique for tumor resection within the sacrum and pelvis was feasible and can achieve ideal resection accuracies. The use of CSGS was associated with high likelihood of negative margin resections in the current series. Intraoperative use of CSGS appeared to be technically straightforward and allowed achievement of planned surgical margins. It is worthwhile to consider the use of CSGS technique in resection of pelvic tumors with sacral invasion and iliosacral tumors, however further follow-up at mid to long-term is warranted to observe local recurrence rate.

scholarly journals Incidence and predictors of kyphotic deformity following resection of cervical intradural tumors in adults: a population-based cohort study

2020 ◽  
Vol 162 (11) ◽  
pp. 2905-2913
Author(s):  
Charles Tatter ◽  
Alexander Fletcher-Sandersjöö ◽  
Oscar Persson ◽  
Gustav Burström ◽  
Per Grane ◽  
...  
Keyword(s):  
Cohort Study ◽  
Tumor Resection ◽  
Population Based ◽  
Magnetic Resonance Images ◽  
Secondary Outcome ◽  
Posterior Fixation ◽  
Intradural Tumor ◽  
Common Diagnosis ◽  
The Mean

Abstract Background The first line of treatment for most cervical intradural tumors is surgical resection through laminotomy or laminectomy. This may cause a loss of posterior pulling force leading to kyphosis, which is associated with decreased functional outcome. However, the incidence and predictors of kyphosis in these patients are poorly understood. Object To assess the incidence of posterior fixation (PF), as well as predictors of radiological kyphosis, following resection of cervical intradural tumors in adults. Methods A population-based cohort study was conducted on adult patients who underwent intradural tumor resection via cervical laminectomy with or without laminoplasty between 2005 and 2017. Primary outcome was kyphosis requiring PF. Secondary outcome was radiological kyphotic increase, measured by the change in the C2–C7 Cobb angle between pre- and postoperative magnetic resonance images. Results Eighty-four patients were included. Twenty-four percent of the tumors were intramedullary, and the most common diagnosis was meningioma. The mean laminectomy range was 2.4 levels, and laminoplasty was performed in 40% of cases. No prophylactic PF was performed. During a mean follow-up of 4.4 years, two patients (2.4%) required delayed PF. The mean radiological kyphotic increase after surgery was 3.0°, which was significantly associated with laminectomy of C2 and C3. Of these, C3 laminectomy demonstrated independent risk association. Conclusions There was a low incidence of delayed PF following cervical intradural tumor resection, supporting the practice of not performing prophylactic PF. Kyphotic increase was associated with C2 and C3 laminectomy, which could help identify at-risk patients were targeted follow-up is indicated.

scholarly journals Elastofibroma: clinical results after resection of a rare tumor entity

2014 ◽  
Vol 6 (2) ◽  
Author(s):  
Hakan Pilge ◽  
Tobias Hesper ◽  
Boris Michael Holzapfel ◽  
Peter Michael Prodinger ◽  
Melanie Straub ◽  
...  
Keyword(s):  
Surgical Resection ◽  
Tumor Resection ◽  
Shoulder Girdle ◽  
Clinical Results ◽  
Clinical Findings ◽  
Thoracic Wall ◽  
Significant Difference ◽  
Reduction Of Pain ◽  
Tumor Entity

Elastofibroma (EF) is a benign proliferation of connective tissue and is typically located at the dorsal thoracic wall. Most patients complain about pain during motion in the shoulder girdle. The aim of our study was to evaluate the outcome after surgical treatment of EF. This study provides an overview of typical clinical findings, diagnostics and pathogenesis of this rare entity. In this retrospective study we analyzed data of 12 patients (6 male, 6 female) with EF treated in our institution between 2004 and 2012. The mean follow-up was 4.7 years (range: 5 months to 7.5 years). All tumors were found to be unilateral and all patients had a negative medical history for EF. Visual analogue scale and range of motion (ROM) was documented pre- and postoperatively. In all patients indication for surgical resection was pain or uneasiness during movement. There was no statistically significant difference in ROM of the shoulder between pre- and postoperatively but all patients reported significantly less pain after surgical resection. Patients benefited from tumor resection by a significant reduction of pain levels and improvement of the motion-dependent discomfort.

scholarly journals Desmoplastic Fibroma: A Case Report with Three Years of Clinical and Radiographic Observation and Review of the Literature

2013 ◽  
Vol 8 (1) ◽  
pp. 40-46 ◽  
Author(s):  
Alexander Nedopil ◽  
Peter Raab ◽  
Maximilian Rudert
Keyword(s):  
Tumor Resection ◽  
Clinical Results ◽  
Ct Scans ◽  
Treatment Modalities ◽  
Desmoplastic Fibroma ◽  
Tumor Extension ◽  
Primary Bone Tumors ◽  
Extra Abdominal Desmoid ◽  
Cortical Involvement

Background: Desmoplastic fibroma (DF) is an extremely rare locally aggressive bone tumor with an incidence of 0.11% of all primary bone tumors. The typical clinical presentation is pain and swelling above the affected area. The most common sites of involvement are the mandible and the metaphysis of long bones. Histologically and biologically, desmoplastic fibroma mimics extra-abdominal desmoid tumor of soft tissue. Case Presentation and Literature Review: A case of a 27-year old man with DF in the ilium, including the clinical, radiological and histological findings over a 4-year period is presented here. CT scans performed in 3-year intervals prior to surgical intervention were compared with respect to tumor extension and cortical breakthrough. The patient was treated with curettage and grafting based on anatomical considerations. Follow-up CT scans over 18-months are also documented here. Additionally, a review and analysis of 271 cases including the presented case with particular emphasis on imaging patterns in MRI and CT as well as treatment modalities and outcomes are presented. Conclusion: In patients with desmoplastic fibroma, CT is the preferred imaging technique for both the diagnosis of intraosseus tumor extension and assessment of cortical involvement, whereas MRI is favored for the assessment of extraosseus tumor growth and preoperative planning. While tumor resection remains the preferred treatment for DF, curettage and grafting prove to be an acceptable alternative treatment modality with close follow-up when resection is not possible. Curettage and grafting have been shown to provide good clinical results and are associated with long recurrence free intervals.

Tentorial Meningiomas: Clinical Results in 81 Patients Treated Microsurgically

Neurosurgery ◽  
2004 ◽  
Vol 55 (1) ◽  
pp. 108-118 ◽  
Author(s):  
Hischam Bassiouni ◽  
Anja Hunold ◽  
Siamak Asgari ◽  
Dietmar Stolke
Keyword(s):  
Tumor Resection ◽  
Clinical Results ◽  
Tumor Location ◽  
Morbidity And Mortality ◽  
Surgical Morbidity ◽  
Presenting Symptoms ◽  
Simpson Grade ◽  
Tentorial Meningioma ◽  
Neuroimaging Data

Abstract OBJECTIVE: Even during the microsurgical era, tentorial meningiomas present a formidable surgical challenge when tumor involves critical neurovascular structures. We report our experience with tentorial meningioma with regard to clinical presentation, diagnostic workup, microsurgical technique, complications, and follow-up results. METHODS: In a retrospective study, we reviewed the medical charts, neuroimaging data, and follow-up data of patients treated microsurgically for tentorial meningioma in our department between January 1989 and June 2002. Patients were routinely scheduled for clinical and radiological follow-up 6 months and 1 year after surgery. Thereafter, follow-up was performed every 1 or 2 years on the basis of the results of each follow-up examination. RESULTS: The main presenting symptoms of the patients (69 women and 12 men) were headache (75%), dizziness (49%), and gait disturbance (46%). The leading neurological signs were gait ataxia (52%) and cranial nerve deficits (28%). Extent of tumor resection was Simpson Grade I in 29 patients, Grade II in 45 patients, Grade III in 1 patient, Grade IV in 4 patients, and unknown in 2 patients. Permanent surgical morbidity and mortality were 19.8 and 2.5%, respectively. Clinical and magnetic resonance imaging follow-up was available in 74 patients for a period ranging from 1 to 13 years (mean, 5.9 yr). Of these, 64 patients (86%) have resumed normal life activity. Seven patients had tumor recurrence and four underwent reoperation. CONCLUSION: Careful preoperative planning of the surgical approach tailored to tumor location and extent is a prerequisite to achieve radical microsurgical tumor resection with minimal morbidity and mortality. Resection of an infiltrated but patent venous sinus is not recommended.

Tibiotalocalcaneal Arthrodesis Using a Soft Tissue–Preserved Fibular Graft for Treatment of Large Bone Defects in the Ankle

2017 ◽  
Vol 38 (6) ◽  
pp. 671-676 ◽  
Author(s):  
Kota Watanabe ◽  
Atsushi Teramoto ◽  
Takuma Kobayashi ◽  
Izaya Ogon ◽  
Yuzuru Sakakibara ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Bone Defects ◽  
Fibular Graft ◽  
Large Bone Defect ◽  
Tibiotalocalcaneal Arthrodesis ◽  
Bony Fusion ◽  
The Mean ◽  
Large Bone ◽  
Large Bone Defects

Background: Pathogenesis of ankle disorders with a large bone defect is varied and treatment for those problems is challenging for orthopaedic surgeons. The aims of this study were to present an operative technique of arthrodesis for the reconstruction of the ankle and hindfoot with a large bone defect using a soft tissue–preserved fibular strut graft and to report outcomes of consecutively treated patients. Methods: Twelve feet from 11 patients, including feet with aseptic necrosis of the talus and total ankle implant loosening, were treated. Bone defects were filled using iliac bone and/or resected fibula and tibiotalocalcaneal arthrodesis was performed using a retrograde intramedullary nail. A modified transfibular approach was used to expose the affected joint while preserving the lateral to posterior skin and soft tissues on the fibula. The periods of bony fusion and outcomes were radiographically and clinically evaluated. The mean follow-up period was 33.4 months. Results: Bony fusion was achieved within 3 months in all cases. Coronal and sagittal alignments were acceptable, and the mean American Orthopaedic Foot & Ankle Score improved from 53.8 to 75.5 at the final follow-up. All patients graded their results of treatment as “satisfied.” Conclusion: This procedure did not require special techniques and it should be applicable to complicated cases with large bone defects. High fusion rates that we believe are due to preserving blood supply to the fibular graft can be expected with preservation of the hindfoot height. Level of Evidence: Level IV, case series.

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