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Epiphysis Salvage Reconstruction and Associated Complications Following Tumor Resections in Skeletally Immature Patients

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Abstract

The purpose of this study was to discuss the epiphysis salvage reconstruction procedure outcomes and complications in skeletally immature patients. The study included 12 patients with pediatric malignant tumors (osteosarcoma, Ewing’s sarcoma) located close to the epiphysis, who underwent epiphyseal-preservation surgery with vascularized fibula in the plastic surgery and orthopedics and traumatology clinic between January 2008 and November 2018. The study was designed retrospectively. Neoadjuvant and adjuvant chemotherapy was administered to all patients. None of the patients received radiotherapy. Functional evaluation was assessed using the Musculoskeletal Tumor Society (MSTS) scoring system. The patients were followed up for a mean period of 51 (21‑115) months. The mean age of patients was 10.4 (range, 5 to 15) years. Union times in the target region (epiphyseal region) and diaphyseal region were reported separately. Accordingly, the mean total union time in the target region of all patients was 7.9 months (5‑11), and the mean total union time in the diaphyseal region was 6.5 months (5‑9). According to the MSTS grading system, the mean score of the patients was 27.50 (range, 21‑30). The mean operative time was 480 (390‑540) min, the mean intraoperative blood loss was 790 (580‑1100) cc, and the mean length of hospital stay was 6 (4‑17) days. Six patients had shortness, 5 patients had delayed union, 3 patients had angular deformity, and 2 patients had infection. Epiphyseal-preservation surgery may be an alternative to other techniques used for malignant tumors located close to the growth line in skeletally immature patients. Despite the fact that this technique has plenty of complications, many of them can be successfully treated with secondary operations without leaving sequelae.

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References

  1. Kim S-Y, Kim Y-G, Hwang J-K (2005) Cementless calcar-replacement hemiarthroplasty compared with intramedullary fixation of unstable intertrochanteric fractures: a prospective, randomized study. JBJS. 87(10):2186–2192

    Google Scholar 

  2. Racano A, Pazionis T, Farrokhyar F, Deheshi B, Ghert M (2013) High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop Relat Res 471(6):2017–2027

    Article  Google Scholar 

  3. Shehadeh A, Noveau J, Malawer M, Henshaw R (2010) Late complications and survival of endoprosthetic reconstruction after resection of bone tumors. Clin Orthop Relat Res 468(11):2885–2895

    Article  Google Scholar 

  4. Kawai A, Lin PP, Boland PJ, Athanasian EA, Healey JH (1999) Relationship between magnitude of resection, complication, and prosthetic survival after prosthetic knee reconstructions for distal femoral tumors. J Surg Oncol 70(2):109–115

    Article  CAS  Google Scholar 

  5. Gupta A, Meswania J, Pollock R et al (2006) Non-invasive distal femoral expandable endoprosthesis for limb-salvage surgery in paediatric tumours. J Bone Joint Surg Brit Vol 88(5):649–654

    Article  CAS  Google Scholar 

  6. Ruggieri P, Mavrogenis AF, Pala E, Romantini M, Manfrini M, Mercuri M (2013) Outcome of expandable prostheses in children. J Pediatr Orthop 33(3):244–253

    Article  Google Scholar 

  7. Saghieh S, Abboud MR, Muwakkit SA, Saab R, Rao B, Haidar R (2010) Seven-year experience of using Repiphysis® expandable prosthesis in children with bone tumors. Pediatr Blood Cancer 55(3):457–463

    Article  Google Scholar 

  8. Staals EL, Colangeli M, Ali N, Casanova JM, Donati DM, Manfrini M (2015) Are complications associated with the Repiphysis® expandable distal femoral prosthesis acceptable for its continued use? Clin Orthop Relat Res 473(9):3003–3013

    Article  Google Scholar 

  9. Picardo N, Blunn G, Shekkeris A et al (2012) The medium-term results of the Stanmore non-invasive extendible endoprosthesis in the treatment of paediatric bone tumours. J Bone Joint Surg Brit Vol 94(3):425–430

    Article  CAS  Google Scholar 

  10. Khattak MJ, Umer M, Umar M (2006) Autoclaved tumor bone for reconstruction: an alternative in developing countries. Clin Orthop Relat Res 447:138–144

    Article  Google Scholar 

  11. Pollock R, Stalley P, Lee K, Pennington D (2005) Free vascularized fibula grafts in limb-salvage surgery. J Reconstr Microsurg 21(02):79–84

    Article  Google Scholar 

  12. Muscolo DL, Ayerza MA, Aponte-Tinao L, Ranalletta M, Abalo E (2004) Intercalary femur and tibia segmental allografts provide an acceptable alternative in reconstructing tumor resections. Clin Orthop Relat Res 426:97–102

    Article  Google Scholar 

  13. Chang DW, Weber KL (2005) Use of a vascularized fibula bone flap and intercalary allograft for diaphyseal reconstruction after resection of primary extremity bone sarcomas. Plast Reconstr Surg 116(7):1918–1925

    Article  CAS  Google Scholar 

  14. Berrey BH Jr, Lord CF, Gebhardt M, Mankin HJ (1990) Fractures of allografts. Frequency, treatment, and end-results. JBJS. 72(6):825–833

    Article  Google Scholar 

  15. Cara JA, Lacleriga A, Cañadell J (1994) Intercalary bone allografts: 23 tumor cases followed for 3 years. Acta Orthop Scand 65(1):42–46

    Article  CAS  Google Scholar 

  16. Muscolo DL, Ayerza MA, Aponte-Tinao LA, Ranalletta M (2004) Partial epiphyseal preservation and intercalary allograft reconstruction in high-grade metaphyseal osteosarcoma of the knee. JBJS. 86(12):2686–2693

    Article  Google Scholar 

  17. Aponte-Tinao L, Ayerza MA, Muscolo DL, Farfalli GL (2015) Survival, recurrence, and function after epiphyseal preservation and allograft reconstruction in osteosarcoma of the knee. Clin Orthop Relat Res 473(5):1789–1796

    Article  Google Scholar 

  18. Li J, Wang Z, Ji C, Chen G, Liu D, Zhu H (2017) What are the oncologic and functional outcomes after joint salvage resections for juxtaarticular osteosarcoma about the knee? Clin Orthop Relat Res 475(8):2095–2104

    Article  Google Scholar 

  19. Enneking W, Dunham W, Gebhardt M, Malawar M, Pritchard D A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res 1993(286):241

  20. Kapukaya A, Suba M, Kandiya E, Özate M, Yilmaz F (2000) Limb reconstruction with the callus distraction method after bone tumor resection. Arch Orthop Trauma Surg 120(3-4):215–218

    Article  CAS  Google Scholar 

  21. Kapukaya A, Subasi M, Arslan H, Tuzuner T, Selek S (2006) Technique and complications of callus distraction in the treatment of bone tumors. Arch Orthop Trauma Surg 126(3):157–163

    Article  Google Scholar 

  22. Hsu R-W, Wood MB, Sim FH, Chao EY (1997) Free vascularised fibular grafting for reconstruction after tumour resection. J Bone Joint Surg Brit Vol 79(1):36–42

    Article  Google Scholar 

  23. Moran SL, Shin AY, Bishop AT (2006) The use of massive bone allograft with intramedullary free fibular flap for limb salvage in a pediatric and adolescent population. Plast Reconstr Surg 118(2):413–419

    Article  CAS  Google Scholar 

  24. Weitao Y, Qiqing C, Songtao G, Jiaqiang W (2012) Epiphysis preserving operations for the treatment of lower limb malignant bone tumors. Eur J Surg Oncol (EJSO) 38(12):1165–1170

    Article  CAS  Google Scholar 

  25. Kiss S, Terebessy T, Szöke G, Kiss J, Antal I, Szendröi M (2013) Epiphysis preserving resection of malignant proximal tibial tumours. Int Orthop 37(1):99–104

    Article  Google Scholar 

  26. Takeuchi A, Yamamoto N, Hayashi K et al (2018) Growth of epiphysis after epiphyseal-preservation surgery for childhood osteosarcoma around the knee joint. BMC Musculoskelet Disord 19

  27. Li J, Shi L, Chen G-j (2014) Image navigation assisted joint-saving surgery for treatment of bone sarcoma around knee in skeletally immature patients. Surg Oncol 23(3):132–139

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Plastic, Reconstructive and Aesthetic Surgery, University of Health Science Adana City Training and Research Hospital, Adana, Turkey

    Rana Kapukaya

  2. Department of Orthopedics and Traumatology, University of Health Science Adana City Training and Research Hospital, Mithat Özhan Bulvarı Kışla Mah. No:1 Yüreğir, Adana, Turkey

    Evren Karaali, Osman Çiloğlu & Hasan Ulaş Oğur

  3. Department of Orthopedics and Traumatology, İstanbul Baltalimanı Bone Disease Training and Research Hospital, Istanbul, Turkey

    Mehmet Baydar & Kahraman Öztürk

Authors
  1. Rana Kapukaya
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  2. Evren Karaali
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  3. Osman Çiloğlu
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  4. Hasan Ulaş Oğur
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  5. Mehmet Baydar
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  6. Kahraman Öztürk
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Contributions

Study concepts: Rana Kapukaya, Evren Karaali, Osman Çiloğlu

Study design: Rana Kapukaya, Evren Karaali, Hasan Ulaş Oğur

Data acquisition: Rana Kapukaya, Mehmet Baydar, Hasan Ulaş Oğur

Quality control of data and algorithms: Rana Kapukaya, Hasan Ulaş Oğur, Mehmet Baydar

Data analysis and interpretation: Rana Kapukaya, Evren Karaali, Mehmet Baydar

Statistical analysis: Rana Kapukaya, Osman Çiloğlu, Hasan Ulaş Oğur

Manuscript preparation: Rana Kapukaya, Evren Karaali, Osman Çiloğlu

Manuscript editing: Rana Kapukaya, Evren Karaali, Mehmet Baydar

Manuscript review: Rana Kapukaya, Evren Karaali, Kahraman Öztürk

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Correspondence to Evren Karaali.

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Kapukaya, R., Karaali, E., Çiloğlu, O. et al. Epiphysis Salvage Reconstruction and Associated Complications Following Tumor Resections in Skeletally Immature Patients. Indian J Surg Oncol 12, 164–171 (2021). https://doi.org/10.1007/s13193-020-01275-4

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  • DOI: https://doi.org/10.1007/s13193-020-01275-4

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