Massive Diaphyseal and Pelvic Bone Allograft for Skeletal Reconstruction S.M. Kumta, J. Kew, L.K. Fu, and P.C. Leung
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ESECTION of bone tumors results in large skeletal defects which need to be suitably reconstructed in order to restore a stable and functional extremity. While autogenous bone remains the best biological means for skeletal reconstruction, the massive size of these defects as well as the limited availability and ensuing morbidity impose significant limitations for its use. Customized and modular prostheses are some of the other available options, but the high cost, lack of long-term durability and mechanical problems are their major disadvantages. Deep frozen and cryopreserved allografts are homostructural with living bone and, although they retain minimal biologic activity, they are an effective means to bridging large intercalary and ostearticular skeletal defects. MATERIALS AND METHODS Since 1989, the musculoskeletal tissue bank has harvested and stored 98 large allografts. Of these, 68 have been used for clinical applications after tumor resection (pelvis: n 5 3; femur; n 5 34;
0041-1345/98/$19.00 PII S0041-1345(98)01232-9 3776
tibia: n 5 27; humerus: n 5 3; ulna: n 5 1). The mean follow-up period ranges from 1 to 8 years (mean, 4.2 years). We assessed the host-allograft union, allograft incorporation, and the influence of vascular bone grafts on the clinical outcome. Excellent results were found in intercalary allograft reconstruction. The overall results were based on the International Society of Limb Salvage scoring system (excellent 12%, good 54%, fair 22%, poor 12%). Articular surface degeneration was evident at 3 years, but this did not impair extremity function. We also reported a 12% rate of wound infection. Limb salvage is a challenging and rewarding option. Massive bone allografts offer the oncologic surgeon a biological option with long-term durability. Allograft, unlike prostheses, may be tailored to the size of the bone defect— offering a major advantage especially when used in children.
From the The Chinese University of Hong Kong Address reprint requests to Dr S.M. Kumta, Prince of Wales Hospital, Room 74040, 5-F Clinical Sciences Building, Shatin, NT Hong Kong, People’s Republic of China.
© 1998 by Elsevier Science Inc. 655 Avenue of the Americas, New York, NY 10010 Transplantation Proceedings, 30, 3776 (1998)