The 2004 Annual Meeting (January 14-20, 2004) of OASYS_NEW

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Vascularized Fibula Grafts for the Treatment of Adamantinoma of the Tibia

Khan SU1, Rishavy TJ1, Bishop AT2, Moran SL3, and Shin A3. (1) Plastic and Reconstructive Surgery, Mayo Clinic, East 6, 200 First Street SW, Rochester, MN, USA, (2) Orthopedic-Hand &Microsurgery, Mayo Clinic, Mayo Clinic, East 14, 200 First Street SW, Rochester, MN, USA, (3) Division of Hand and Microsurgery, Division of Plastic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA

Background

Adamantinoma of the long bones is a slow growing rare primary malignant tumor of bone origin. The most common anatomic site of origin is the tibia. Current management strategies recommend en bloc resection of tumor and limb salvage. It has been suggested that vascularized bone grafts can reduce the risk of complications after reconstructive procedures for large segmental bone defects, particularly infection, nonunion, and fracture. The purpose of this study was to evaluate the long-term efficacy of vascularized fibular grafts for reconstruction of tibial defects after resection of primary adamantinoma.

Methods

This study represents a retrospective evaluation of a single institutional experience utilizing vascularized fibular grafts for reconstruction after limb salvage procedures for the resection of tibial adamantinoma. Data was compiled for ten (10) patients who underwent such procedures at our institution between 1982 and 1996.

Results

Long term follow-up data were available for all 10 patients (100%). The mean time of follow-up was 146 months (range, 60-234 months). The average age at diagnosis was 24 years. The average length of resected tibia was 16.8 cm, and the average length of harvested vascularized fibular graft was 21.5 cm. There were no donor site complications related to the fibula graft harvest. The infection and nonunion complication rates were 10% and 20%, respectively. There were no instances of vascular thrombosis related to the graft pedicle. There were no local recurrences or evidence of metastatic disease in any of our patients. The overall limb salvage rate was 100%(10/10) and there were no deaths related to recurrent disease in our patient population. One patient died of unrelated causes 10 years after treatment.

Conclusion

Despite the small number of patients, this single institution review of vascularized fibula grafts for the treatment of adamantinoma of the tibia supports the current recommendations that en bloc resection and reconstruction for limb salvage should be the primary treatment modality for this rare bone tumor. We also believe that the vascularized fibula graft represents an excellent reconstructive option with reasonable morbidity rates and excellent limb salvage rates.


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