RESULTS OF LIMB-SALVAGE SURGERY USE WIDE RESECTION SURGERY AND VASCULARIZED FIBULAR GRAFTS

Hoang Lac Bui1,, Xuan Vu Tong1, Van Tho Le1, Chi Dung Le1
1 Hospital for Traumatology and Orthopaedics

Main Article Content

Abstract

Background: Limb-salvage treatment for malignant and borderline bone tumors are still difficult and challenging. There are a lot of methods of treatment but results are still limited. We use wide resection surgery and vascularized fibular grafts for limb-salvage treatment for our patients. Objective: Evaluation orthopedic and oncology results of  limb-salvage surgery use wide resection surgery and vascularized fibular grafts. Materals and methods: 45 cases of malignant and borderline bone tumor at humerus, radial, tibia were treated  by operation at Bone and Joint Pathology Department in Hopital for Trauma and Orthopaedic at Ho Chi Minh City from 2005 to 2020. Methods: Prospective study, evaluation of bone healing according to Hsu, graft hypertrophy according to De Boer and Wood, function was documented according to the MSTS. Evaluate the local recurrence rate, malignant transformation,distant metastasis and death, Overall survival time, Disease Free Survival time. Results: 1. Orthopedic results: 100% bone healing, average bone healing time 5.20 ± 0.68 months. Bone graft hypertrophy 43.9%. The mean limb function according to MSTS was 81% ± 8.65%. 2. Oncology results: Local recurrence in cases (4.4%), do not malignant transformation, rate of metastasis and death in 8 cases (17.8%) . The mean  overall survival time was 155.3 ± 10.1months.The mean  disease free survival time 150.2 ± 10.1 months. The overall survival rate and the 5-year disease free survival rate were 79.1%. Conclusions: The limb-salvage surgery of malignant and borderline bone tumor use wide resection surgery and vascularized fibular grafts gives good Orthopedic and Oncology results.

Article Details

References

1. Lê Chí Dũng. Bướu xương: lâm sàng- hình ảnh y học – giải phẫu bệnh và điều trị. Nhà xuất bản y học. 2003: 28-76.
2. Hsu R.W., Wood M.B., Sim F.H., Chao E.Y. Free vascularised fibular grafting for reconstruction after tumour Resection. J Bone Joint Surg Br. 1997. 79(1): 36–42. DOI: 10.1302/0301-620x.79b1.6818.
3. De Boer H.H., Wood M.B. Bone changes in the vascularized fibular graft. J Bone Joint Surg (Br). 1989. 71-B: 374-378. DOI: 10.1302/0301-620X.71B3.2722923.
4. Enneking W.F. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal System. Clin Orthop Relat Res. 1993. 286:
241-246. DOI:10.1097/00003086-199301000-00035.
5. Eward W.C., Kontogeorgakos V., Levin L.S., et al. Free Vascularized Fibular Graft Reconstruction of Large Skeletal Defects after Tumor Resection. Clin Orthop Relat Res. 2010. 468: 590–598. DOI: 10.1007/s11999-009-1053-x.
6. Gebert C., Hillmann A., Schwappach A. Free Vascularised Fibular Grafting for Reconstruction After Tumor Resection in the Upper Extremity. Journal of Surgical Oncology. 2006. 94: 114127. DOI: 10.1002/jso.20326.
7. Zelenski.N., Brigman B.E., Levin L.S., et al. The Vascularized Fibular Graft in the Pediatric Upper Extremity: A Durable, Biological Solution to Large Oncologic Defects. Hindawi Pubshing Corporation, sarcoma. Article ID321201. 2013: 7. DOI: 10.1155/2013/321201.
8. Minami A., Kutsumi K., Takeda N., et al. Vascularized fibular graft for bone reconstruction of the extremities after tumor resection in limb-saving procedures. Mcrosurgery. 1995. 16: 56-64. DOI: 10.1002/micr.1920160204.
9. Gorski S.M., Dong C., Krieg A.H. Vascularized Bone Graft Reconstruction Following Bone Tumor Resection at a Multidisciplinary Sarcoma Center: Outcome Analysis. Anticancer Research. 2021. 41: 5015-5023. DOI: 10.21873/anticanres.15316.
10. Chen CM., Disa J.J., Lee H.Y., et al. Reconstruction of Extremity Long Bone Defects after Sarcoma Resection with Vascularized Fibula Flaps: A 10-Year Review. Plast. Reconstr. Surg. 2007. 119: 915-929. DOI: 10.1097/01.prs.0000252306.72483.9b.
11. Emori M., Kaya M., Irifune H., et al. Vascularised fibular grafts for reconstruction of extremity bone defects after resection of bone and soft-tissue tumours. Bone Joint J. 2017. 99-B: 1237– 1243. DOI: 10.1302/0301-620X.99B9.BJJ-2017-0219.R1.
12. Hariri A., Mascard E., Atlan F., et al. Free vascularised fibular graft for reconstruction of defects of the lower limb after resection of tumour. J Bone Joint Surg Br. 2010. 92(11): 1574–1579. DOI: 10.1302/0301-620X.92B11.23832.
13. Claxton M.R., Shirley M.B., Bakri K., et al. Utility of the Free Vascularized Fibula Flap to Reconstruct Oncologic Defects in the Upper Extremity. Anticancer Research. 2020. 40: 27512755. DOI: 10.21873/anticanres.14246.