Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Rabitsch, K.
Allograft reconstruction in the treatment of musculoskeletal tumours
a comparative analysis
[ Diplomarbeit ] Medical University of Graz; 2012. pp. 95
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Leithner Andreas
- Maurer-Ertl Werner
- Altmetrics:
- Abstract:
- Allograft reconstructions after wide resection have a long history and are quite popular in treatment of musculoskeletal tumours. Sarcoma patients are now having a considerable improved prognosis as a result of multimodal therapy concept, combining chemotherapy with wide resection and - when indicated - additional radiation, and a high percentage of generally young patients is now surviving their disease. In the light of these developments, durability of reconstruction is of growing interest. It¿s the aim of this diploma thesis to work out how long allograft reconstructions last as well as the complications compromising the outcome and their frequencies. Medical records of patients who received an allograft reconstruction at the Department of Orthopaedics Surgery Graz were scanned and two reconstruction types were analysed retrospectively. Six patients with osteoarticular allografts for reconstructions of distal radius and fourteen patients with a vascularised fibula combined with a massive allograft for intercalary reconstructions of lower limb formed these groups. Since the number of cases at the Department of Orthopaedics Surgery in Graz is quite low, the results of this study are not representative for allograft reconstructions in general. That¿s why a literature review was done additionally to supplement and compare our results to answer the question of durability. None of the allograft reconstructions performed at the Department of Orthopaedics Surgery Graz failed. Five patients developed nonunion, three in the fibula group and two in the radius group. In the fibula group four patients sustained plate breakage with consecutive fracture and two patients developed infection. All complications could be treated successfully without compromising the final outcome. In literature similar results in terms of complication rates and encouraging survival rates were found for these reconstruction types. In literature review it could be further worked out that intercalary allograft and allograft prosthetic composite reconstructions are durable and likely to last for the whole duration of patients¿ life. In osteoarticular allografts around the knee, however, complication and failure rates were found to be quite high and survival rates were discouraging. Osteoarticular allografts are probably one of the best solutions for reconstructions of the distal radius, but at other anatomic regions they aren¿t providing a durable reconstruction, because of their high complication and failure rates. Intercalary allografts, especially in combination with an autologous vascularised fibula and allograft prosthesis composites, however, provide a durable reconstructive solution. Allografts are a great option in limb salvage surgery, but their usage must be considered together with other reconstructive alternatives in regard of the localisation and characteristics of tumour as well as of patient¿s needs and expectations.