Background
Reconstruction of massive bone defects following resection of bone sarcoma is challenging. There are a variety of options for reconstruction including biological, endoprosthetic and combined methods. We report our experience using combined extracorporeal radiotherapy and reimplantation autograft with vascularised fibula bone graft as one such method of reconstruction for limb salvage.
Methods
We present a case series of 3 patients who have had bone sarcomas treated with wide excision and intercalary reconstruction with this described technique over a 6-year period at Christchurch Hospital, New Zealand.
Results
Three patients with two cases of Ewings’ sarcoma and one case of Osteosarcoma were treated between 2018-2024. One tibia, one femur and one humerus were the primary sites of disease. Patients were all female and 11,12 and 21 years old. All patients received neoadjuvant and adjuvant chemotherapy. One patient required a complex total hip joint replacement for avascular necrosis of the femoral head. Another patient required FHL tendon release from her fibula harvest. Two patients show radiological evidence of boney union at the proximal and distal reconstruction sites. There are no cases of tumour recurrence.
A description of the operative technique (including handling and preparation of the tumour specimen, logistics, transportation, processing in the radiotherapy lab, radiotherapy dosage and final inset with fibula) with photographs will be included.
Conclusion
There is currently a paucity of evidence regarding which reconstructive method gives patients the best outcomes following surgical treatment of bone sarcomas. This combination method is an option that provides the biological properties of the vascularised fibula bone graft with the mechanical properties of the irradiated bone autograft.