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Allograft Reconstruction Following Segmental Femoral Bone Tumor Resection
Douglas J. McDonald, M.D.
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Material Covered: "Most of the people that have giant cell tumors are younger adults or adolescents who have a lot of activities they want to participate in as well as normal day-to-day functions of living. The opportunity for them to keep their leg and to avoid amputation is primary in their minds, probably more than the specific type of reconstruction they will be subject to. Under these circumstances the patients are generally willing to undergo this type of aggressive procedure, knowing that there are potential complications and risks, because they have so much to gain by keeping their leg." -- Douglas McDonald, M.D. The management of muscle cell neoplasms is challenging, not only in terms of the orthopaedic problems involved, but also because many patients require complex, multidisciplinary care by raidiologists, pathologists, and medical oncologists experienced with the advanced types of treatment needed. Advancements in all the specialties mentioned have made routine the choice of reconstruction versus amputation for both treatment team and patient. Over the past decade many specialized orthopaedic surgeons have performed large allograft reconstruction procedures in patients requiring tumor resection of the lower limb. Early results are encouraging for both benign and malignant disorders. Since 1983, 80 large fragment allograft procedures specifically for tumor surgery (benign and malignant) have been performed in the department of orthopaedics at St. Louis University Medical Center. Sixty of the patients have been followed for a minimum of two years. St. Louis University assistant professor of orthopaedics Dr. Douglas McDonald compiled a series of three allograft reconstruction cases for the VJO from surgery to follow-up. All three patients had tumors of the femur, two benign and one malignant. Case 1: a 32-year-old woman with a giant cell tumor in the distal femur with no intra-articular extension. A distal femoral total osteoarticular graft is used to reconstruct the femur/joint after tumor resection. Case 2: a 22-year-old man with a recurrent giant cell tumor of the distal femur. Two years previously the patient underwent surgery for a partial osteoarticular allograft of the lateral condyle. The initial allograft failed because of tumor recurrence and an irregular fracture of the allograft. In this patient, an allograft knee joint arthrodesis is completed using both a long intramedullary fusion nail and bilateral compression plate fixation. Case 3: a 14-year-old woman with an osteosarcoma of the distal femur. After chemotherapy and biopsy (6 weeks prior), wide-resection of both lesion and surrounding tissue margins of the distal femur is completed. Allograft/prosthetic composite reconstruction was completed with a hinged type prosthesis. To complete the procedure a local medial gastrocnemius muscle flap is used to cover the reconstruction. "Most of the people that have giant cell tumors are younger adults or adolescents who have a lot of activities they want to participate in as well as normal day-to-day functions of living. The opportunity for them to keep their leg and to avoid amputation is primary in their minds, probably more than the specific type of reconstruction they will be subject to. Under these circumstances the patients are generally willing to undergo this type of aggressive procedure, knowing that there are potential complications and risks, because they have so much to gain by keeping their leg." -- Douglas McDonald, M.D. The management of muscle cell neoplasms is challenging, not only in terms of the orthopaedic problems involved, but also because many patients require complex, multidisciplinary care by raidiologists, pathologists, and medical oncologists experienced with the advanced types of treatment needed. Advancements in all the specialties mentioned have made routine the choice of reconstruction versus amputation for both treatment team and patient. Over the past decade many specialized orthopaedic surgeons have performed large allograft reconstruction procedures in patients requiring tumor resection of the lower limb. Early results are encouraging for both benign and malignant disorders. Since 1983, 80 large fragment allograft procedures specifically for tumor surgery (benign and malignant) have been performed in the department of orthopaedics at St. Louis University Medical Center. Sixty of the patients have been followed for a minimum of two years. St. Louis University assistant professor of orthopaedics Dr. Douglas McDonald compiled a series of three allograft reconstruction cases for the VJO from surgery to follow-up. All three patients had tumors of the femur, two benign and one malignant. Case 1: a 32-year-old woman with a giant cell tumor in the distal femur with no intra-articular extension. A distal femoral total osteoarticular graft is used to reconstruct the femur/joint after tumor resection. Case 2: a 22-year-old man with a recurrent giant cell tumor of the distal femur. Two years previously the patient underwent surgery for a partial osteoarticular allograft of the lateral condyle. The initial allograft failed because of tumor recurrence and an irregular fracture of the allograft. In this patient, an allograft knee joint arthrodesis is completed using both a long intramedullary fusion nail and bilateral compression plate fixation.
Case 3: a 14-year-old woman with an osteosarcoma of the distal femur. After chemotherapy and biopsy (6 weeks prior), wide-resection of both lesion and surrounding tissue margins of the distal femur is completed. Allograft/prosthetic composite reconstruction was completed with a hinged type prosthesis. To complete the procedure a local medial gastrocnemius muscle flap is used to cover the reconstruction.
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