Wrist Arthrodesis with Vascularized Fibular Graft after Failed Allograft Replacement for Giant-Cell Tumor Resection

Giant-cell tumor (GCT) is locally aggressive bone neoplasm, with an unpredictable pattern of biological aggressiveness. The optimal treatment had to achieve a negligible local recurrence rate while maximizing musculoskeletal function. Numerous options for reconstruction are available, but in the literature there is a lack of salvage surgery data. We present a case of a 67-year-old woman who underwent complete wrist arthrodesis with vascularized fibular graft as salvage procedure for allograft necrosis, after excision of a distal radius GCT. The patient did not complain of any impairment in daily use, and the functional score was 22 points (73%) at latest follow-up of 14 months. Despite joint salvage remains the most favorable treatment with regard to functional outcome for aggressive tumors of the distal radius, vascularized fibular grafts is a valuable alternative especially in salvage procedures, where the use of another allograft could lead to higher complications rate. Keywords: Vascularized fibular graft, Wrist arthrodesis, Giant-Cell Tumor, Fibula free flap.

Surgical management of giant cell tumor in adolescent by excision or curettage followed by fibular strut graft

<p class="abstract">Giant cell tumour (GCT) in adolescent is a rare tumour. It commonly occurs in skeletally mature patients aged between 20-40 years. In adults it is seen in epiphyseal region. In patients with intact physis, it arises from the metaphysis. Giant cells are more common in females. It is more common in the ends of long bones of distal end of femur, proximal tibia, and distal radius. 14 cases of surgical management of GCT by excision or curettage in adolescent followed by fibular strut graft. 1 year follow up of all cases of GCT in adolescent treated with excision or curettage followed by fibular strut graft was done. Out of 14 patients, 12 patients did not develop any recurrence of GCT. 2 patient developed recurrence after 6 months. All the patients were able to attain good range of movements 2 months after surgery. GCT in adolescent surgically treated with excision or curettage followed by fibular graft had excellent results in terms of recovery of daily activities, wound healing. Chances of recurrence more in patients treated with curettage and bone grafting.</p><p class="abstract"> </p>

Ectopic gas in the fibular graft after anterior cervical corpectomy and fusion

Background Ectopic gas in the graft is occasionally encountered upon follow-up computed tomography (CT) after anterior cervical corpectomy and fusion (ACCF). However, most cases lack inflammatory responses and manifestations of infection. Although the clinical significance of ectopic gas in the graft has not yet been established, to the best of our knowledge, no previous studies have described ectopic gas in the graft after ACCF. This study evaluated ectopic gas in the fibular graft upon follow-up CT after ACCF. Methods We reviewed 112 patients who underwent ACCF and follow-up CT, with a minimum follow-up period of 3 years. CT images were retrospectively reviewed to confirm the presence of ectopic gas in the graft and bone fusion. Bone fusion was defined as follows: mobility less than 2 mm between spinous processes on the flection-extension radiograph or a bone bridge on CT images. Results Of the 112 patients, 30 (27%) patients had ectopic gas in the fibular grafts. Among them, ectopic gas was initially observed 3 months after surgery (early onset) in 23 (77%) patients and 6 months after surgery (late-onset) in the remaining seven (23%) patients. Upon the latest follow-up CT, ectopic gas more frequently remained in late-onset (4/7, 57%) rather than in early-onset (3/23, 13%) cases (p = 0.033). Bone fusion was not observed when CT images exhibited ectopic gas in the graft, whereas ectopic gas was not observed when CT images exhibited bone fusion. Conclusion Ectopic gas in the fibular graft was observed at both early and late-onset after ACCF; late-onset gas remained significantly. The remaining gas was strongly associated with pseudoarthrosis; therefore, pseudoarthrosis should be considered when ectopic gas in the graft is observed on CT images.

Mandibular reconstruction with microvascularized graft after ameloblastoma resection: case series

Ameloblastoma is a locally aggressive and highly infiltrative tumor with a high recurrence rate. Its multicystic form the recommended treatment is resection with a safety margin, which results in significant facial defects with esthetic and functionals repercussions. Microvascular surgery revolutionized the reconstruction of significant defects because these grafting techniques allow a more satisfactory aesthetic and functional restoration. This study aimed to report a series of cases of reconstructions of mandibular defects using microvascularized fibular graft after ameloblastoma resection. Six patients were included in this study, and we collected data related to the surgical procedure, diagnosis, complications and follow-up. The patients were characterized as four women and two men, with a mean age of 23.8 years, with a diagnosis of mandibular ameloblastoma located mainly in the body, angle and mandibular ramus. These patients underwent lesion resection, resulting in defects larger than 5 cm, which justified using a microvascularized fibular graft for its reconstruction. The patients evolved well, with good results and without recurrences or complications in a postoperative follow-up of 2 to 5 years. Ameloblastoma is a lesion that reaches large dimensions and causes excellent cosmetic and functional damage. The microvascularized graft is an alternative in reconstructing significant defects and allows satisfactory morphofunctional reestablishment with minimal complications.

A Case Series: Non-vascularized Autologous Fibular Graft in the Treatment of Major Segmental Bone Defect after Post-traumatic at Diaphyseal Femur

BACKGROUND In the management of bony defects, autologous bone grafts can be used as the mechanical structure for reconstruction to restore aesthetics and function, Non-vascularized autologus fibular graft are often used to the treat large post traumatic defects caused by high-energy trauma with open fracture and nonunion cases for 1st and 2nd cases. Here we would like to present a 16-year-old woman and a 37-year-old man patients of major bone defect at the right femoral shaft region using 9 cm and 10 cm non-vascularized fibular autogenous grafts. OBJECTIVE The purpose of this case report was to determine the effectiveness of non-vascularized autologus fibular graft for major bone defect at the regio femoral shaft for the reconstruction of post traumatic case. MATERIAL AND METHODS We treat post traumatic of the major bone defect at the regio femoral shaft with 9 cm and 10 cm femoral non-vascularized autologus fibular graft and fixed by a limited contact dynamic compression plate and femoral locking plate methode by routine phisioteraphy. RESULTS The Patient have a good result with good functional outcome after open reduction internal fixation (ORIF) and using a non-vascularized autologus fibular graft for treating the major bone defect after post traumatic femoral shaft fracture. CONCLUSION Complete and comperhensive open reduction internal fixation (ORIF) with autologous non- vascularized fibular graft, stabilized fracture by limited contact dynamic compression plate for 1st patient and femoral locking plate for 2nd patient allowing with an early rehabilitation is an acceptable, Phisioteraphy and early mobilisation resulting better outcome for the patient, all of this are less expensive, can be accepted at the hospitals that limited facilities and health professionals for professional subspeciality and widely reproducible option to manage bone defects in open shaft femoral fractures to achieving union, preserving length and motion with no donor site morbidity, giving patients good functional outcome and radiologic result. KEYWORDS Major bone defect, non-vascularized autologus fibular graft, autologous bone grafts, femoral shaft fracture, Open Fracture, Muskuloskeletal Reconstruction, Bone Loss, Nonunion.

Lengthening and deformity correction in vascularized fibular autograft for a patient with Ewing sarcoma

We report the case of a pediatric patient with Ewing’s sarcoma of the tibia treated with vascularized fibular autograft where the resulting limb deformity and leg length discrepancy (LLD) were corrected using Ilizarov external fixator. A 14-year-old girl presented to our outpatient clinic with a deformity of the right proximal and distal tibia and an 11.7 cm of LLD after tumor reconstruction surgery. Deformity correction and limb lengthening were simultaneously performed using double corticotomy on the right proximal and distal tibia. One year postoperatively, the union of the right proximal tibia had progressed, but nonunion was observed at the right distal corticotomy site. To address this, osteosynthesis with tricortical iliac bone allograft was performed after the removal of the Ilizarov external fixator. After 6 months, the union of the distal tibia was confirmed, and the varus deformity of proximal and distal tibia improved. The LLD was also decreased, but the left lower limb was still longer by 3 cm. This report shows that vascularized fibular autografts can potentially be used for the gradual correction of LLD and deformities. However, for the treatment of multiple deformities in bones previously reconstructed with vascularized fibular graft, the possibility of impaired bone forming potential of the fibular graft should be considered.

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

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.