Reconstruction for malignant bone tumor defects by a composite graft--plasty of the bone defect not involving a joint
Shinjo, K.
Nihon Seikeigeka Gakkai Zasshi 67(1): 22-33
1993
ISSN/ISBN: 0021-5325 PMID: 8454923 Document Number: 410221
Malignant bone tumors excluding joints of six patients were resected. The resultant bone defects were reconstructed with a synthetic fabric-enveloped hydroxyapatite spacer in five cases and a filler in one. Dacron fabric was used in four cases and each of Marlex mesh and Dexon mesh were used in one. The grafting and reconstruction processes were studied clinically and roentgenographically. CT scan was used in one case. The synthetic fabrics were helpful in repairing released supporting soft tissue by serving as a scaffold for the formation of new connective tissue. The spacer to the supporting soft tissues was biologically fixed. The synthetic fabrics were capable of inducing and supporting of the ingrowth of vascular connective tissue. The anchor of reconstructed supporting soft tissue became increasingly strong as time passed. For lasting and stable reconstruction, the spacer must be made uniform with the remaining bone by making an extracortical bone bridge using an autogenous bone graft. In two cases, autogenous bone grafts were taken from the ilium to bridge the remaining bone. The autogenous bone grafts were fixed to the spacer by enveloping the bone graft and the spacer with Marlex mesh and Dexon mesh. In the Marlex case roentgenographic findings showed that extracortical bone bridging was completed within six months after the operation. In the Dexon mesh case, extracortical bone bridging was not completed at one year after the operation, however the repair of the released supporting soft tissues was satisfactory. In order to avoid complications, a fabric must be absorbed fully after completion of the biologic fixation and extracortical bone bridging. Yet, further investigations are required to determine which of the synthetic fabrics and mesh sizes to enhance incorporation of the bone graft.