Autoplasty of post-resection defects of long bones in modern treatment of osteogenic sarcoma in children

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Abstract

High survival rate obtained in the treatment of osteogenic sarcoma resulted in substitution of organ-removing operations to organ-saving ones. Methods of total joint replacement used in adult practice can not be so widely applied in paediatric practice due to incompleteness of skeleton growth in children. The solution of the problem is the methods of autoplasty using the fibula including free transplantation, transposition of fibula with nutritional tissue mass and plasty by vascularized graft. Fibula autoplasty is efficient in application with the complex of antineoplastic chemotherapy and postoperative management of patients as well as the treatment of possible complications. This is confirmed by the data of examination of 91 patients with osteogenic sarcoma, aged 4—15, who were treated at Oncology Department of the Russian Paediatric Clinical Hospital in the period from 1987 to 1998.

 

About the authors

V. I. Kovalev

Russian Children's Clinical Hospital

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Moscow

A. Yu. Starostina

Russian Children's Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Moscow

V. A. Strykov

Russian Children's Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Moscow

D. V. Kovalev

Russian Children's Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Moscow

A. V. Bystrov

Russian Children's Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Moscow

A. V. Borodachev

Russian Children's Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Moscow

M. S. Loseva

Russian Children's Clinical Hospital

Email: info@eco-vector.com
Russian Federation, Moscow

References

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2. Rice. 1. Patient S., 12 years old. Osteogenic sarcoma of the proximal metadiaphysis of the left humerus.a - radiograph before surgery; b — after surgery: the post-resection defect was replaced with an autograft from the fibula, the position of the autograft and the axis of the limb were satisfactory; c — appearance of the patient 1 year after the operation.

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3. Rice. 2. Patient P., 10 years old. Osteogenic sarcoma of the proximal metadiaphysis of the right tibia.a - radiographs before surgery; b — 8 months after the operation: the axis of the graft is satisfactory, the formation of calluses and thickening of the graft are pronounced; c — after the dismantling of the Ilizarov apparatus: the axis of the limb was not changed; d — appearance 1 year after surgery: the limb is fixed in an orthosis, debatable.

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4. Rice. 3. Patient Sh., 10 years old. Significant involvement of the lower half of the left femur with osteogenic sarcoma.a — radiographs before surgery; b — 2 years after the operation: pronounced synostosis between the grafts and synostosis of the “upper” graft with the proximal femoral stump; c — appearance 2 years after the operation: the limb is fixed in an orthosis. The child moves without the use of additional means of support. Good cosmetic effect.

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