Biological reconstruction in the treatment of extremity sarcoma in femur, tibia, and humerus

To understand the feasibility, clinical effect, and complications related to biological reconstruction techniques for long limb malignant bone tumors after excision. This retrospective study included eighty patients with malignant bone tumors treated at our hospital between January 2007 and January 2019. After tumor resection, 52 cases of intercalary and 28 cases of osteoarticular bone grafts were used. The implanted bone included devitalized recycling bone, fibular, and allograft. The average follow up period was 42.19 months for 80 patients, among whom 15 (18.75%) died. The 5-year EFS and OS were 58% and 69%, respectively. The average length of the replanted bone was 18.57 cm. The MSTS scores of intercalary and osteoarticular bone grafts were 87.24% and 64.00%, respectively. In 23 cases (44.23%) of metaphyseal and 26 cases (32.5%) of the diaphysis, bone graft union was obtained at the first stage. The factors affecting bone union were the patient's gender, age, devitalization bone methods and whether the implanted bone was completely fixed. Postoperative complications included delayed bone union in 15 patients, fractures in 25 cases, nonunion in 22 cases, bone resorption in 14 cases, and postoperative infection in 4 cases. Twenty-eight cases of bone grafting required revision surgery, including replacement of internal fixation, autologous bone graft, debridement, removal of internal fixation, and replacement with prosthetic replacement. Biological reconstructions with massive bone grafts are useful in the reconstruction of certain malignant extremity bone tumors after wide excision.