Biological Reconstruction for Sarcoma

Copyright © 2013 Andreas Leithner et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Particularly in children and young adults, bone allografts and autografts seem to be a perfect and long-lasting alternative to the use of prostheses after bone resection due to bone or soft tissue sarcomas. However, several topics like osteoarticular massive allografts are still discussed controversially. Might allograft-prosthetic composites reconstructions serve as stable and durable alternatives? Questions like this as well as the long-term results have not been answered sufficiently yet. In a review, L. A. Holzer and A. Leithner focus on the historical highlights, the present role, and possible future options for biological extremity reconstruction. While hand transplantation is already an option, above-elbow transplan-tation or limb regeneration might become a topic in the future. K. Rabitsch et al. report their experience with intercalary reconstructions of the lower limb using a vascularized fibula and an allograft in 12 patients. Although the event-free survival was only 51% at a two-year follow-up full weight bearing was achieved in all cases with all autografts still in place. The authors conclude that this method is a stable and durable reconstruction technique. M. Niethard et al. illustrate their technique using bilateral vascularized fibular grafts for reconstruction of metadiaphy-seal defects of the femur and tibia in 11 patients. Despite a similar complication rate as reported by K. Rabitsch et al., all of the complications were manageable without the loss of the biological reconstruction. The authors also report on the increased risk of fixation failure after radiotherapy. L. E. Ritacco et al. describe the workflow for structural allograft selection of their renowned three-dimensional virtual bone bank system. Preoperative planning includes a 3D CT-derived bone model to define the exact size and shape in comparison to the planned resection. F. Traub et al. provide a retrospective analysis of their experience in biological reconstruction following the resec-tion of pelvic tumors. Twenty-seven patients were evaluated for oncological as well as clinical and functional outcome. Hip transposition was used in 16 patients, and autologous nonvascularized fibular grafts were used in five patients. Despite the difficult situation after pelvic resection, MSTS score (mean 16.5) was good or excellent in most of the patients. The second paper by K. Rabitsch et al. reports on the technique of distal …