Treatment outcome of reconstruction using free vascular fibular transfer with pre and post-operative chemotherapy after resection of lower limb osteosarcoma in children and adolescents

Abstract EN

77zj?s srwrfy included 9 patients with osteosarcoma in the lower limb who had 3 cycles of (Doxorubicin and Cis-platin) pre-operative combination chemotherapy followed by wide local resection and reconstruction by vascularised fibula osteoseptocutaneous flap and three postoperative chemotherapy cycles, their surgeries had been performed at least 24 months before the end of the study.

The average age at operation was 14.1 years.

All tumors were high-grade osteosarcoma (stage HA, IIB).

The tumor volume averaged 220.9 cc (range 41.5-400).

The resulting defect after tumor resection averaged 16 cm (range 11-20).

All flaps survived.

All grafts united in an average period of 3.8 months (range 3-6) after transfer.

Full weightbearing was possible after an average period ofsix months (range 6-8).

Significant hypertrophy (> 30% of the original fibular diameter) occurred in all patients after an average period of 10 months from the index operation.

In the latest follow-up radiographs (mean; 35.4 months), the degree of hypertrophy averaged 90.8% (range 30-200%).

Graft fracture occurred in one patient after plate removal and healed conservatively.

Shortening averaged 1.4 cm (range 0-3).

The Musculoskeletal Tumor Rating Score (MTSRS) averaged 22 points at the end of the first postoperative year and 23 at the end of the study.

There were three deaths because of lung metastasis at a mean time of 29 months (range 22 -38).

The remaining six patients (66.66%) remained disease free for an average of 40 months (range 24-65).