Allograft Alone vs. Allograft with Intramedullary Vascularized Fibular Graft

Allograft Alone vs. Allograft with Intramedullary Vascularized Fibular Graft for Lower Extremity Bone Cancer: A Systematic Review and Meta-Analysis:



Publication date: Available online 18 February 2020

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Sammy Othman, Jonathan T. Bricker, Saïd C. Azoury, Omar Elfanagely, Kristy L. Weber, Stephen J. Kovach

Abstract

Background

Limb-salvage surgery has become a first-line treatment in the setting of lower extremity cancer. Despite a multitude of techniques, the most effective modality for osseous reconstruction has not been described. We aim to examine outcomes of allograft reconstruction alone compared to an allograft combined with a vascularized fibula graft (VFG) (Capanna Technique) through a meta-analysis of the literature.

Methods

A systematic review of the literature was conducted through the online databases PubMed, Embase, and Web of Science, examining for articles utilizing an allograft with or without an intramedullary VFG for reconstruction of lower extremity osseous defects following oncologic resection. A meta-analysis examined outcomes, including nonunion, infection, fractures, explantation, and functional limb status, that were evaluated dependent upon reconstructive modality.

Results

Twenty-five articles were deemed appropriate for inclusion. The allograft with VFG group had considerably lower rates of nonunion (13%) in comparison to the allograft alone group (21.4%) (p < .001). Rates of infection (7.9% vs. 9%, respectively) and fracture (19.6% vs. 19.1%) were not statistically different. The allograft with VFG group also had significantly lower rates of explantation (6.57%) compared to the allograft alone cohort (18.11%) (p < .001). Functional outcomes were similar across groups as measured by Musculoskeletal Tumor Society scores (88.22% vs. 87.77%)

Conclusions

Allograft reconstruction with a supplementary inlay VFG decreases risk of nonunion and explantation compared to allograft alone reconstruction in the setting of oncologic resection of the osseous lower-extremity. This technique warrants increased consideration in the operative planning of lower-limb reconstruction following tumor extirpation.