The application research of vascularized fibular periosteum grafting in irradiated bone segment replantation for treatment of limb bone tumor in children
Wang Xin, Liu Zhiyong, Li Po, Tian Zhichao, Cai Qiqing
Department of Bone and Soft Tissue, the Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou 450008, China
Abstract：Objective To investigate the feasibility and clinical effect of union promotion of vascularized fibular periosteum grafting, in irradiated bone segment replantation for treatment of limb bone tumor.Methods Eight cases of malignant or invasive bone tumors of the extremities were retrospectively analyzed in the Department of Bone and Soft Tissue, the Affiliated Cancer Hospital of Zhengzhou University, 4 males and 4 females, average age (13.6±2.5) years, ranged 9-17 years.There were 5 osteosarcoma, 1 Ewing sarcoma, 1 Langerhans cell histocytosis with recurrence several times, and 1 chondrosarcoma.All patients underwent enlarged resection of the tumor segment and intraoperative inactivation of the autologous tumor segment. The replanted tumor segment was covered with pedicle or free periosteal periosteal flap.The lesions were located in 5 tibia, covered the distal end of irradiated segment with ipsilateral pedicled fibular periosteum for union promotion; 2 lesions were located in middle and distal femur, and 1 lesion was located in middle humerus, covered the proximal end of irradiated segment with free fibular periosteum. Average length of resect bone was (18.1±3.9) cm, ranged 13-26 cm, constiuted of 3 osteoarticular segment and 5 intercalary segment. The method of inactivation of bone segment was intraoperative extracorporal irradiation. Regular postoperative fellow-up, X ray and CT were applied to observe bone union time, and the length of the affected limb were recorded.Results All patients were followed up by mean time of (18.8±3.5) months, range 12-24 months. Thirteen ends of irradiated-host bone in 8 patients got union completely. The mean time to union of irradiated segment-host end covered by fibular periosteum was (7.3±1.3) months, range 6-10 months, region of end covered by periosteum showed excellent osteogenic power. There was no leg length discrepancy occurred in 5 patients who received intercalary inactivation and 1 patient who received osteoarticular inactivation because of the preservation of growth plate or mature of growth plate, but 2 osteoarticular inactivated patients suffered leg length discrepancy of 1.5 cm and 2 cm respectively at last follow-up.Conclusions Transplantation of vascularized fibular periosteum can effectively promote the union of irradiated bone segment after replantation, prevent non-union, with simple operation and fewer complications in the surgical treatment of limb bone tumor in children.
王鑫, 刘志勇, 李坡, 田志超, 蔡启卿. 腓骨骨膜瓣移植在儿童四肢骨肿瘤瘤段骨射线灭活回植术中的应用观察[J]. 中华解剖与临床杂志, 2019, 24(1): 6-10.
Wang Xin, Liu Zhiyong, Li Po, Tian Zhichao, Cai Qiqing. The application research of vascularized fibular periosteum grafting in irradiated bone segment replantation for treatment of limb bone tumor in children. Chinese Journal of Anatomy and Clinics, 2019, 24(1): 6-10.
Xu S, Yu X, Xu M, et al. Limb function and quality of life after various reconstruction methods according to tumor location following resection of osteosarcoma in distal femur[J]. BMC Musculoskelet Disord, 2014, 15: 453. DOI:10.1186/1471-2474-15-453
[2]
Wu PK, Chen CF, Chen CM, et al. Intraoperative extracorporeal irradiation and frozen treatment on tumor-bearing autografts show equivalent outcomes for biologic reconstruction[J]. Clin Orthop Relat Res, 2018, 476(4): 877-889. DOI:10.1007/s11999.0000000000000022. DOI:10.1007/s11999.0000000000000022
[3]
Davidson AW, Hong A, McCarthy SW, et al. En-bloc resection, extracorporeal irradiation, and re-implantation in limb salvage for bony malignancies[J]. J Bone Joint Surg Br, 2005, 87(6): 851-857. DOI:10.1302/0301-620x.87b6.15950
Soldado F, Knörr J, Haddad S, et al. Vascularized tibial periosteal graft in complex cases of bone nonunion in children[J]. Microsurgery, 2015, 35(3): 239-243. DOI:10.1002/micr.22342
[7]
Nau C, Henrich D, Seebach C, et al. Treatment of large bone defects with a vascularized periosteal flap in combination with biodegradable scaffold seeded with bone marrow-derived mononuclear cells: an experimental study in rats[J]. Tissue Eng Part A, 2016, 22(1-2): 133-141. DOI:10.1089/ten.tea.2015.0030
Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft[J]. Plast Reconstr Surg, 1991, 87(2): 290-298. DOI:10.1097/00006534-199102000-00011
[13]
Soldado F, Fontecha CG, Barber I, et al. Vascularized fibular periosteal graft : a new technique to enhance bone union in children[J]. J Pediatr Orthop, 2012, 32(3): 308-313. DOI:10.1097/bpo.0b013e31824b2843
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