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Aims: The use of frozen tumour-bearing autograft combined with a vascularized fibular graft (VFG) represents a new technique for biological reconstruction of massive bone defect. We have compared the clinical outcomes between this technique and Capanna reconstruction., Methods: From June 2011 to January 2016 a retrospective study was carried out of patients with primary osteosarcoma of lower limbs who underwent combined biological intercalary reconstruction. Patients were categorized into two groups based on the reconstructive technique: frozen tumour-bearing autograft combined with concurrent VFG (Group 1) and the Capanna method (Group 2). Demographics, operating procedures, oncological outcomes, graft union, limb function, and postoperative complications were compared., Results: A total of 23 patients were identified for analysis: eight in Group 1 and 15 in Group 2. There was no difference in the demographics (age, sex, and affected site) and operating procedures (resection length, duration of surgery, and blood loss) between the two groups. No significant difference was found in local recurrence in Group 1 versus Group 2 (p = 0.585). Mean union time for the frozen autograft-host junction was 8.4 months (7.0 to 11.0), significantly earlier than for the allograft-host junction in Group 2 (mean 14.1 months (10.0 to 28.0); p < 0.001). Mean Musculoskeletal Tumor Society scores in groups 1 and 2 were 90.3% (SD 7.4%) and 88.0% (SD 9.0%), respectively, with no significant statistical difference (p = 0.535). In terms of complications, infection (n = 1, 6.7%) and delayed union (n = 2, 13.3%) occurred in Group 2, but no such complications were observed in Group 1., Conclusion: Frozen tumour-bearing autograft in combination with VFG can be used as an alternative to the Capanna reconstruction in properly selected patients with osteosarcoma. Cite this article: Bone Joint J 2020;102-B(5):646-652.

Background: The Capanna technique involves the use of a vascularized fibular graft inlaid in a massive bone graft in intercalary reconstruction for diaphyseal long-bone defects caused by tumor resection. Allograft-host union time varies in different reports, and few studies have focused on the underlying factors affecting union time. The purpose of the present study was to analyze factors relevant to union time and to report complications of the Capanna technique., Methods: We identified 60 patients who underwent segmental reconstruction with use of the Capanna technique following tumor resection (in the humerus in 10 patients, the femur in 33 patients, and the tibia in 17 patients). Multivariable linear multiple regression model analysis was performed with allograft-host osseous union time as the dependent variable. Union time was evaluated on radiographs. Independent variables included age, tumor site, adjuvant treatment, a previous surgical procedure, defect length, fixation method, and fibular viability. A retrieved specimen of the composite was histologically assessed., Results: The mean defect length was 16 cm. All allografts and host bone united, with the mean time to union of 13 months (range, 6 to 27 months). Prolonged union time was associated with devitalization of the fibular graft (p < 0.001), use of chemotherapy (p = 0.031), and a previous surgical procedure (p = 0.048). Patient age (p = 0.742), amount of resection (p = 0.907), operative site (p = 0.508), and fixation method (p = 0.105) were not associated with union time. On histological analysis, we found that the allograft-host cortical junction was united by callus from both periosteum of the host bone and the fibula., Conclusions: The Capanna technique appears to be a reliable method for intercalary reconstruction with a low rate of complications. Devitalization of the transplanted fibula, chemotherapy, and a previous surgical procedure are adverse factors leading to prolonged union time., Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The purpose of this study was to examine whether the results of a reconstruction using frozen autograft in combination with vascularized fibula are comparable to other reconstructive methods in limb-salvage surgery for tibial sarcoma with regard to the functional outcome and complications. Between 2008 and 2012, nine patients with bone sarcoma of the tibia underwent excision of the affected segment that was then frozen and reimplanted with an ipsilateral vascularized fibular graft within it. Patients were examined clinically and radiographically. The mean follow-up was 48.8 months. The mean time to full weight-bearing was 6.2 months and to complete radiological union 6.8 months at the conjunction. One patient required a mid-thigh amputation due to local recurrence in soft tissue. No local recurrence arising from the frozen autograft was detected. Complications included wound dehiscence in 1, clawed toes in 1, temporary peroneal nerve palsy in 1, and stress fracture in 1. The average musculoskeletal tumor society functional score was 94.5%. Combination of a frozen tumor-bearing autograft and ipsilateral pedicled fibula is an effective reconstruction for massive bone defect arising from resection of bone sarcoma in tibia. This approach has the advantage of combining the biological properties offered by the vascularized bone graft with the mechanical endurance of the frozen autograft. The method is best indicated for intercalary defects of the tibia for selected patients. Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

Background: Pediatric reconstruction of lateral malleolus was necessary and challengeable. Up to now, vascularized fibular was the optimal graft to reconstruct epiphyseal defection. However, the sophisticated microvascular operation has limited the wide application of this technique. Case Presentation: We present the case of a 9‐year‐old boy with Ewing sarcoma in left distal fibula. In order to restore the growth capacity, we used reverse‐flow vascularized fibular epiphyseal graft with tibialis anterior artery to reconstruct the bone defect after tumor resection with no microvascular anastomosis. More than 4 years after the operation and adjuvant chemotherapy, the patient was free of pain and recurrence, and the function and stability of ankle joint was perfect. Radiology examination revealed satisfied bony union of fibula and normal growth of the fibular head transplant. Conclusions: The advantage of reverse‐flow vascularized fibular epiphyseal graft is requiring no microvascular anastomosis which could not only shorten operating time, but also reduce factitious damage of vessels. This report presented that this technique might be an available option for reconstruction of lateral malleolus in children. [ABSTRACT FROM AUTHOR]

Background: The Capanna technique involves the use of a vascularized fibular graft inlaid in a massive bone graft in intercalary reconstruction for diaphyseal long-bone defects caused by tumor resection. Allograft-host union time varies in different reports, and few studies have focused on the underlying factors affecting union time. The purpose of the present study was to analyze factors relevant to union time and to report complications of the Capanna technique.Methods: We identified 60 patients who underwent segmental reconstruction with use of the Capanna technique following tumor resection (in the humerus in 10 patients, the femur in 33 patients, and the tibia in 17 patients). Multivariable linear multiple regression model analysis was performed with allograft-host osseous union time as the dependent variable. Union time was evaluated on radiographs. Independent variables included age, tumor site, adjuvant treatment, a previous surgical procedure, defect length, fixation method, and fibular viability. A retrieved specimen of the composite was histologically assessed.Results: The mean defect length was 16 cm. All allografts and host bone united, with the mean time to union of 13 months (range, 6 to 27 months). Prolonged union time was associated with devitalization of the fibular graft (p < 0.001), use of chemotherapy (p = 0.031), and a previous surgical procedure (p = 0.048). Patient age (p = 0.742), amount of resection (p = 0.907), operative site (p = 0.508), and fixation method (p = 0.105) were not associated with union time. On histological analysis, we found that the allograft-host cortical junction was united by callus from both periosteum of the host bone and the fibula.Conclusions: The Capanna technique appears to be a reliable method for intercalary reconstruction with a low rate of complications. Devitalization of the transplanted fibula, chemotherapy, and a previous surgical procedure are adverse factors leading to prolonged union time.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]