Principles of Defect Reconstruction After Wide Resection of Primary Malignant Bone Tumors of the Calcaneus: A Contemporary Review.
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ABSTRACT:
SUBMITTER: Toepfer A
PROVIDER: S-EPMC11316265 | biostudies-literature | 2024 Jul
REPOSITORIES: biostudies-literature
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Principles of Defect Reconstruction After Wide Resection of Primary Malignant Bone Tumors of the Calcaneus: A Contemporary Review.
Toepfer Andreas A Potocnik Primoz P Harrasser Norbert N Schubert Thomas T Khan Zeeshan Z Farei-Campagna Jan Marino JM
Foot & ankle orthopaedics 20240701 3
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Project description:BackgroundAllograft reconstruction following the resection of malignant bone tumors is associated with high rates of complications and failures. This study aimed to evaluate the efficacy and current problems of allograft reconstruction techniques to optimize treatment strategies at our center.Materials and methodsThirty-eight cases (16 men and 22 women), who were diagnosed with malignant bone tumors and had undergone allograft reconstruction, were recruited. Allograft was fixed by intramedullary nail, single steel plate, double plate, and intramedullary nail combined plate in 2, 4, 17, and 15 cases, respectively. Allograft union, local recurrence, and complications were assessed with clinical and radiological tests. Tumor grade was assessed using the Enneking staging of malignant bone tumors. Functional prognosis was evaluated by the Musculoskeletal Tumor Society (MSTS) scoring system.ResultsIntercalary and osteoarticular reconstructions were performed in 32 and 6 cases, respectively. Six patients underwent reoperation related to allograft complications, four patients had local recurrence, and three patients with allograft fracture underwent allograft removal. A total of eight host-donor junctions showed nonunion, including seven cases (18.4%) in diaphysis and one case (3.1%) in metaphysis (p < 0.01). Host rejection and secondary osteoarthritis occurred in nine and two cases, respectively. No deep infection and internal fixation device fracture occurred. The overall allograft survival rate was 81.6%. Postoperative MSTS score of patients with allograft survival was 26.8 ± 2.9, indicating a significant improvement as compared to their preoperative function.ConclusionsAllograft represents an excellent choice for intercalary bone defects after malignant bone tumor resection. Robust internal fixation protection across the whole length of the allograft is an important prerequisite for the survival of the allograft, while multidimensional osteotomy, intramedullary cement reinforcement, and pedicled muscle flap transfer can effectively improve the survival rate and healing rate of the allograft.
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Project description:BackgroundIn the reconstruction of the affected limb in pediatric malignant bone tumors, since the loss of joint function affects limb-length discrepancy expected in the future, reconstruction methods that not only maximally preserve the joint function but also maintain good limb function are necessary. We analysis limb function of reconstruction methods by tumor location following resection of pediatric malignant bone tumors.Patients and methodsWe classified the tumors according to their location into 3 types by preoperative MRI, and evaluated reconstruction methods after wide resection, paying attention to whether the joint function could be preserved. The mean age of the patients was 10.6 years, Osteosarcoma was observed in 26 patients, Ewing's sarcoma in 3, and PNET(primitive neuroectodermal tumor) and chondrosarcoma (grade 1) in 1 each.ResultsType I were those located in the diaphysis, and reconstruction was performed using a vascularized fibular graft(vascularized fibular graft). Type 2 were those located in contact with the epiphyseal line or within 1 cm from this line, and VFG was performed in 1, and distraction osteogenesis in 1. Type III were those extending from the diaphysis to the epiphysis beyond the epiphyseal line, and a Growing Kotz was mainly used in 10 patients. The mean functional assessment score was the highest for Type I (96%: n = 4) according to the type and for VFG (99%) according to the reconstruction method.ConclusionThe final functional results were the most satisfactory for Types I and II according to tumor location. Biological reconstruction such as VFG and distraction osteogenesis without a prosthesis are so high score in the MSTS rating system. Therefore, considering the function of the affected limb, a limb reconstruction method allowing the maximal preservation of joint function should be selected after careful evaluation of the effects of chemotherapy and the location of the tumor.
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Project description:BackgroundConventional surgical treatment for metacarpal giant cell tumours (GCTs) includes lesion scraping followed by bone grafting or bone cement filling and en bloc resection followed by repair and reconstruction using a vascularised bone flap. However, these methods have inherent shortcomings, including a high postoperative recurrence rate and poor mechanical stability. 3D-printing techniques are increasingly being applied in medicine, and 3D-printed personalised prostheses have achieved good clinical effects in orthopaedic repair and reconstruction. We aimed to investigate the clinical effects of 3D-printed personalised prostheses for bone defect repair and reconstruction following resection of metacarpal GCTs.MethodsThree patients with metacarpal GCTs were examined in a retrospective cohort study. Through preoperative planning, a 3D-printed personalised prosthesis was designed and created for bone defect repair and reconstruction after tumour resection. Prosthesis fit, limb function, pain on the affected side, and the occurrence of complications were evaluated postoperatively.ResultsPostoperative X-ray examination revealed a satisfactory fit of the 3D-printed prosthesis in terms of bone defect size and overall metacarpal shape, as well as good transverse and longitudinal metacarpal arches. The patients also exhibited good function in the affected limb, with good flexion and extension functions in the carpal, metacarpophalangeal, and interphalangeal joints, plus the absence of obvious pain, tumour recurrence, and complications such as pathologic fractures and prosthetic loosening.ConclusionsWhen using a 3D-printed personalised prosthesis for bone defect repair and reconstruction following resection of metacarpal GCTs, a good fit with the bone defect can be achieved during prosthetic installation when preoperative planning and design have been adequately performed. Therefore, three-dimensionally printed personalised prostheses can serve as an effective method for the treatment of metacarpal GCTs.
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Project description:Primary malignant bone tumor of the pelvis is an uncommon lesion, the resection of which via freehand osteotomy is subject to inaccuracy due to its three-dimensional anatomy. Patient-Specific Guides (PSG), also called Patient-Specific Instruments (PSI) are essential to ensure surgical planning and resection adequacy. Our aim was to assess their use and effectiveness. A monocentric retrospective study was conducted on 42 adult patients who underwent PSG-based resection of a primary malignant bone tumor of the pelvis. The primary outcome was the proportion of R0 bone margins. The secondary outcomes were the proportion of overall R0 margins, considering soft-tissue resection, the cumulative incidence of local recurrence, and the time of production for the guides. A comparison to a previous series at our institution was performed regarding histological margins. Using PSGs, 100% R0 safe bone margin was achieved, and 88% overall R0 margin due to soft-tissue resection being contaminated, while the comparison to the previous series showed only 80% of R0 safe bone margin. The cumulative incidences of local recurrence were 10% (95% CI: 4-20%) at one year, 15% (95% CI: 6-27%) at two years, and 19% (95% CI: 8-33%) at five years. The median overall duration of the fabrication process of the guide was 35 days (Q1-Q3: 26-47) from the first contact to the surgery date. Patient-Specific Guides can provide a reproducible safe bony margin.
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Project description:ObjectiveTo introduce a novel 3D-printed prosthetic composite for reconstruction of massive bone defects after resection for bone malignancy of lower extremities. The design concept, surgical technique, and the preliminary outcomes were elaborated.MethodsPatients with primary malignant tumors of lower extremities requiring tumor resection and reconstruction were recruited between Jun 2015 and Nov 2018. Patient-specific 3D-printed prostheses were designed according to preoperative imaging data. After tumor resection, reconstruction was performed with composites consisting of 3D- printed prosthesis, beta-tricalcium phosphate (β-TCP) bioceramics and/or vascularized fibula. All patients underwent regular follow-up postoperatively. The functional outcomes were assessed by the Musculoskeletal Tumor Society score (MSTS). Oncological outcomes, imaging results, and complications were recorded and analyzed.ResultsTen cases averaging 12.90 years of age participated in this study. There were five femur and five tibia reconstructions. The mean follow-up period was 16.90 months. At last follow-up, all patients were alive without tumor recurrence. Average MSTS functional score was 80.33 ± 11.05%. All prostheses were intact and stable without failure or systemic breakage. No serious complications occurred after the operation. Postoperative X-ray, computed tomography (CT) and single-photon emission computed tomography (SPECT) showed an ideal integration between the bone and the prosthetic composite. Moreover, vascularized fibula and implanted β-TCP bioceramics indicated relatively high metabolic activity in vivo.ConclusionsPatient-specific 3D-printed prostheses combined with β-TCP bioceramics and/or vascularized fibula provide an excellent option for reconstruction of massive bone defects after lower extremity malignant tumor extirpation. Short-term follow up showed promising clinical results in recovering lower limb function, promoting osseointegration and reducing complications.
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Project description:The acetabular bone defect reconstruction is of great challenge in total hip arthroplasty (THA). Although several solutions such as autologous bone grafting, trabecular metal augment, or compromising techniques such as the medial protrusion, high inclination angle, and elevated hip center have been raised, their efficacy and reliability have not been fully substantiated. Traditional reconstruction methods may lead to bone resorption, aggravation of bone defects, unequal length of lower limbs, unbalance of hip-spine relationship, increased costs, and so on. Our team proved a new technique named extra-articular blocking to resolve this problem. The extra-articular blocking technique was a simple, economic and effective acetabular reconstructive method to resolve the massive acetabular bone defect in congenital (especially for developmental dysplasia of the hip, DDH), inflammatory, and osteolytic pathologies. This article organized as surgical technique, aims to report the surgical principle, indication, and procedure of using extra-articular blocking technique. With this technique, we have successfully solved the difficult problem of acetabular bone defect reconstruction. We found after 3 months of the surgery, there were fluoroscopic healing and remodeling. And there were no bone loss or graft absorption until the last follow-up as evidenced by radiographic observation. The survival rate of the acetabular component was 100%, no radiolucent line, changes in inclination and anteversion of the shell, as well as migration of the rotation center were identified.
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Project description:Bone-patellar tendon-bone (BPTB) autograft is a popular graft choice for anterior cruciate ligament reconstruction (ACLR) in active young adults. In case of BPTB ACLR failure, the 3 most popular autograft choices for a revision surgery include contralateral BPTB, contralateral or ipsilateral hamstrings autograft, and contralateral or ipsilateral quadriceps tendon autograft. Quadriceps tendon autograft has been gaining increasing popularity in recent years in this respect, but using quadriceps tendon-bone autograft in the setup of a previous use of ipsilateral BPTB autograft deserves special technical considerations, with emphasis on preserving patellar bone integrity. We describe a technique for performing revision ACLR after failed primary BPTB ACLR by using ipsilateral quadriceps tendon-bone autograft in the setup of persistent distal patellar bone defect. Using this autograft benefits the advantages of highly resilient graft tissue in addition to fast bone-to-bone healing on the femoral side, and it can be an excellent choice in revision reconstruction for surgeons who prefer tendon-bone autograft for highly active young adults and specifically when the patients underwent bilateral primary autologous BPTB ACLRs.
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Project description:ObjectivesOronasal fistulas are common sequelae following cleft lip and palate surgery and can significantly impact a patient's quality of life. They result from various factors, including surgical techniques, tissue management, and patient-specific factors. This case report explores the modern approach to oronasal fistula closure using periodontal plastic surgery principles.Materials and methodsThe report presents two cases of patients with oronasal fistulas due to previous maxillofacial surgical intervention. These patients underwent microsurgical procedures that involved partial flap thickness preparation of the fistula areas, the use of connective tissue grafts from the palate, and meticulous suturing techniques to ensure graft integrity. The procedures were performed in stages, and postoperative care was provided.ResultsBoth cases demonstrated successful fistula closure and graft survival. The patients reported improvements in breathing, speech, aesthetics, and quality of life. The second case also included guided bone regeneration and implant placement.ConclusionsOronasal fistulas resulting from maxillofacial surgery can be effectively treated using periodontal plastic surgery techniques, significantly improving patients' quality of life and aesthetic outcomes. This approach represents a valuable addition to the existing repertoire of oronasal fistula closure methods.
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Project description:BackgroundDespite significant improvements in oncological treatment, the management of soft tissue defects following malignant tumor resection remains challenging. We investigated whether autologous menisci and cruciate ligament, which are traditionally discarded, can be recycled as a supplemental flap in repairing soft tissue defects following malignant bone tumor resection and endoprosthetic reconstruction around the knee.MethodsFour knee specimens were dissected to provide a basis for the design of the menisci-cruciate ligament composite. Then, 40 patients with bone malignancies around the knee were enrolled and underwent reconstruction with free or vascularized composite following malignant tumor resection. The clinical, radiographic, and functional outcomes of this technique were evaluated in >1-year follow-up in each patient and compared with 87 patients who suffered from bone malignancies around the knee and were treated by limb salvage but without composite at our center over the same period. During the follow-up, a composite from one patient who underwent secondary amputation was retrieved and examined for in vivo remodeling.ResultsFourteen patients were treated with vascularized composite transfer (10 distal femurs and 4 proximal tibias) and 26 patients with free composite transfer (19 distal femurs and 7 proximal tibias). The composite can be used to cover the area of soft tissue defect from 22 to 48.38 cm2 (34.67 ± 6.48 cm2 ). With contrast-enhanced ultrasound, peripheral rim healing and dotted blood flow signal at the side of anastomosis were detected on a patient 16 months after free composite transfer. Gross macroscopic remodeling and histopathologic analysis of a retrieved composite also indicated good healing with surrounding tissues and living cells in the composite. The complications and oncologic outcomes were comparable between study and control cohorts, but better Musculoskeletal Tumor Society (MSTS) score for patients reconstructed with composite (26.68 vs. 25.66, p = 0.004). Of note, MSTS score was higher for patients reconstructed with composite at distal femur subdivision compared with the same subdivision in the control cohort (26.97 vs. 25.90, p = 0.009). No statically significant difference was noted in complications, oncologic, and functional outcomes for patients reconstructed with free or vascularized composite.ConclusionAutogenous menisci-cruciate ligament composite is an alternative option for soft tissue reconstruction. Either vascularized or free composite can be applied, depending on the size and localization of the defect.
| S-EPMC10134327 | biostudies-literature