Intercalary segmental reconstruction after bone tumor resection

Abstract 

Background/aims

Intercalary resection can be used for primary as well as metastatic tumors. Reconstruction options include vascularized fibula graft, interposition of an allograft, combination of vascularized fibula and allograft, segmental prosthesis, insertion of an extracorporally irradiated autograft, segmental transportation, either with external fixation or by using an intramedullary rod, intercalary scaffolds augmented with growth factors, and technical refinements for the resection of tumors located close to the growth plate. The purpose of this review is to discuss the indications, limitations and pitfalls of each of these techniques.

Methods

The PubMed database was searched for articles on intercalary reconstruction after bone tumor resection and for the different reconstruction options presented in this review. Additionally, cross-referencing was used to cover articles eventually undetected by the respective search strategies. The resulting articles were then reviewed with regard to the different techniques, outcomes and complications of the reconstruction options.

Results

With the advance of imaging techniques and the use of chemotherapy for malignant bone tumors, surgical techniques can be refined. There are many techniques for the reconstruction of large intercalary defects of long bones, with which the orthopedic oncologist needs to be familiar. General oncologic principles of achieving a wide margin still need to be respected.

Conclusion

The techniques presented in this review will allow a better functional outcome of patients. It will continue to be important to carefully analyze each patient's situation and to adapt and individualize the method of reconstruction used.

Keywords: Tumor resection, Bone defect, Intercalary, Segmental, Vascularized fibula, Allograft, Tumor prosthesis, Extracorporal irradiation, Segmental transport