A hollow, custom-made prosthesis combined with a vascularized flap and bone graft for skeletal reconstruction after bone tumour resection. (March 2021)

• Record Type: Journal Article
• Authors: Beltrami, Giovanni; Ristori, Gabriele; Galeotti, Alberto; Scoccianti, Guido; Tamburini, Angela; Campanacci, Domenico; Capanna, Rodolfo; Innocenti, Marco
• Is Part Of: Surgical oncology. Volume 36(2021)
• Page Start: 56
• Page End: 60
• Publication Date: 2021-03
• Subjects: Vascularized flap -- Custom-made prosthesis -- 3D printing; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2020.11.014
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Purpose: While limb-sparing surgery is now possible for more than 80% of patients with bone tumours, wide resection is often required, necessitating bone reconstruction. This paper aims to present a surgical technique that combines the advantages of a hollow, titanium, custom-made prosthesis and the biological aspects of microsurgical flaps and bone graft. Patients and methods: From June 2016 to September 2017 at our institution, six consecutive patients with skeletal tumours underwent one-stage reconstructive surgery with concomitant implantation of a 3D-printed prosthesis. Results: At an average follow-up of 30 months (range: 18–45), no early complications were observed, and no implant removals were needed. One patient experienced a delayed haematogenous deep infection, which healed after surgical debridement. Three patients died of their underlying disease 18, 22, and 23 months after surgery, respectively. All flaps and custom reconstructions were successful, with primary osseointegration at a mean of four months (range: 2–7). Patients' average Musculoskeletal Tumour Society score was 23.2 (range: 18–28). Conclusion: A hollow, custom-made, titanium prosthesis filled with bone graft, used in conjunction with a microsurgical flap, may offer good osseointegration in different anatomic locations among a patient population with a high risk of infection, pseudarthrosis, and long-term mechanical complications. The surgical technique's advantages are preliminarily demonstrated. Further studies with longer follow-up periods and larger sample sizes are required to confirm our findings. Highlights: Limb-sparing surgery is possible in more than 80% of bone tumour cases. Free vascularized bone grafts are frequently used for bone reconstruction. Molding of the vascularized bone graft to the resected bone is technically demanding. Hollow, custom-made titanium prostheses may add to the surgical armamentarium. The prostheses can be filled with bone autograft, allograft or cement.