Limb-Saving Surgery by Intraoperative Radiation and Vascularized Fibular Graft for Osteosarcoma.

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Various limb-saving surgeries for osteosarcomas have been performed owing to the high survival rate achieved by chemotherapy. However, reconstruction by endoprosthesis after radical resection of the tumor in the distal femur or proximal tibia was often complicated by early or late severe problems. The radicality of intraoperative radiation by Lineac 50Gy for osteosarcoma has been proved clinically by Yamamuro et al, while radiation therapy often ensued pathological fractures. Therefore, for osteosarcomas in four distal femurs and one proximal tibia, we have adopted a vascularized fibular graft to reinforce the irradiated bone and to prevent the collapse of the joint surface. Resected osseous parts were irradiated in four cases with resultant infectionsin two cases.Intraoperative irradiation without resection was performed on one case with an uneventful short course. Although the ranges of motion in three survivors were limited, the prospect of limb-saving surgery by intraoperative irradiation and incorporated vascularized fibular grafts seem favorable as they promise longer durability.
西日本整形・災害外科学会の論文