Irradiation of the Resected Bone and Vascularized Fibular Graft in the Limb-Saving Surgery for Osteosarcoma:A case report

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A new method of limb-saving for osteosarcoma is reported. After wide resection of the tumor, intra-operative irradiation of 50Gy to the resected bone was performed. Then, the radiated bone which had been curetted before radiation only preserving cortex, subchondral bone or ligamentous attachment, was re-implanted and fixed by a plate. Vascularized fibula with cancellous proximal portion was also implanted to facilitate bony union and to prevent bone necrosis. Cancellous bone chips were packed in subchondral region to prevent articular collapse. Articular ligaments were repaired to secure stability of the knee joint.For osteosarcoma of the left proximal tibia in a 17-year-old girl, irradiation to the resected bone by Electron 12MeV, 50Gy was performed. Then, the ipsilateral fibula with vascular pedicle was translocated into the irradiated and re-implanted bone. Although the patella tendon was repaired, the patient walked well with good functioning quadriceps and good range of motion in spite of slight instability of the knee joint, which was rated as excellent by Ennekin's criteria.Although intra-operative irradiation of 50Gy is proved to be curative for osteosarcoma by Yamamuro or others, curettage of the resected bone before the irradiation will eliminate the risk of recurrence of the tumor. Vascularized fibular graft facilitates the bony union, and with cancelous bone graft in subchondral region may prevent the collapse of articular surface.
西日本整形・災害外科学会の論文

Irradiation of the Resected Bone and Vascularized Fibular Graft in the Limb-Saving Surgery for Osteosarcoma:A case report

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