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Bilaterales Fibulainterponat

Biologische Rekonstruktion nach Resektion primär maligner Knochentumoren

Bilateral fibula graft

Biological reconstruction following resection of malignant bone tumors

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Zusammenfassung

Ziel der Rekonstruktion ossärer Defekte der langen Röhrenknochen der unteren Extremität nach Resektion primär maligner Knochentumoren ist es, ein möglichst langfristiges Ergebnis zu erreichen. Es wird über die Rekonstruktion von metadiaphysären Defekten mittels eines bilateralen Fibulatransplantates berichtet. Im Zeitraum zwischen 11/2000 und 12/2003 wurde bei 5 Patienten (Durchschnittsalter: 15,2 Jahre) nach Resektion eines malignen Knochentumors (Ewing-Sarkom n=4, Osteosarkom n=1) eine biologische Rekonstruktion mittels eines bilateral gefäßgestielten Fibulatransplantates in Kombination mit einer Plattenosteosynthese vorgenommen. Die Tumoren waren im Femur (n=3) und in der Tibia (n=2) lokalisiert. Die zu rekonstruierende Defektlänge betrug im Median 16,4 cm (11,5–23 cm). Alle Patienten wurden im Rahmen des EURO-E.W.I.N.G. 99- bzw. COSS-96-Protokolls multimodal therapiert. Die Nachbeobachtungszeit beträgt im Median 34 Monate. In allen Fällen wurde eine R0-Resektion des Primärtumors erzielt. Lokalrezidive traten nicht auf. Die Vollbelastung der betroffenen Extremität erfolgte nach einem Zeitintervall von 8–18 Monaten. Komplikationen traten bei 4 Patienten auf (Nachblutung: n=1, Pseudarthrose + Infektion: n=1, Fraktur des Fibulainterponates: n=1, Materialbruch: n=1). Keine der Komplikationen führte zu einem Versagen der Rekonstruktion oder zur Amputation. Der MSTS-Score ist 2-mal sehr gut, 2-mal gut und einmal befriedigend. Die biologische Rekonstruktion ossärer Defekte ist, wenn immer möglich, anzustreben. Im Bereich der unteren Extremität ist neben einer hohen Stabilität durch die Anwendung eines bilateralen Fibulatransplantates ein gutes funktionelles Ergebnis zu erreichen.

Abstract

Bilateral vascularized fibula graft (BVFG) is actually not a satisfying method for the replacement of metadiaphyseal defects of the femur and tibia in young patients suffering from malignant bone tumors. This reconstruction was used in five patients (two female, three male, average age 15.2 years, femur n=3, tibia n=2) undergoing metadiaphyseal resection of malignant bone tumors between November 2000 and August 2003. The median length of the defect to be bridged was 16.4 cm (range 11.5–23). In the two cases of tibia reconstruction, the ipsilateral fibula was transposed into the osseous defect (fibula pro tibia). The vessels of the contralateral fibula graft were microscopically anastomosed end-to-side upon the a. and v. tibialis anterior. For the reconstruction of femoral defects, two free fibula grafts were used. All patients had multimodal treatment according to the EURO-E.W.I.N.G 99 or COSS-96 protocol. Median follow-up was at 34 months. In all cases, R0 status was achieved. None of the patients experienced local recurrence during follow-up. Radiographic signs of osseous remodeling were detected the earliest after 2 months. Full weight-bearing on the affected leg was permitted after 8–18 months. Complications occurred in four patients (bleeding 1, infection and pseudarthrosis 1, fracture 1, plate fracture 1). None of the complications led to failure of the reconstruction or to amputation. The MSTS scores was very good in two patients, good in two, and intermediate in one. Biological reconstruction of osseous defects is always desirable when possible. Good functional and durable results can be obtained using BVFG for the reconstruction of metadiaphyseal defects of the femur and tibia.

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  1. Klinik für Chirurgie und Chirurgische Onkologie, Charité Campus Buch, Robert-Rössle-Klinik am Helios Klinikum Berlin, Lindenberger Weg 80, 13122 , Berlin

    P.-U. Tunn, T. K. Moesta & H. Delbrück

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  1. P.-U. Tunn
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  2. T. K. Moesta
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Correspondence to P.-U. Tunn.

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Tunn, PU.., Moesta, T.K. & Delbrück, H. Bilaterales Fibulainterponat. Chirurg 77, 919–925 (2006). https://doi.org/10.1007/s00104-006-1210-7

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