Biological Reconstruction in Bone Sarcomas: Lessons from Three Decades of Experience

Objective To review research on all patients treated by biological reconstruction after resection of bone sarcomas between 1987 and 2015 at our hospital. Methods One thousand one hundred and sixty‐seven cortical allografts and 166 cortical autografts were retrospectively analyzed. Radiological studies had been performed to determine the timing of consolidation of the grafts at both the metaphyseal and diaphyseal osteotomies. A prospective isotopic study with 99 T c was done in order to evaluate the revascularization of allografts. Histological, immunohistochemistry and fluorescence techniques were used on retrieved allografts to evaluate their integration. Complications, functional results and possible relationships with human leukocyte antigen ( HLA ) compatibility, were also reviewed. Results The mean age of these patients with bone sarcomas was 19 years (range, 3–69 years). The mean length of cortical allografts was 19.5 cm (range, 4–42 cm) and of autografts 8 cm (range, 6–15 cm). The mean consolidation time of diaphyseal osteotomies was 16 months. The mean time to consolidation was 5 months for vascularized autografts and 12 months for non‐vascularized grafts. New bone formation was observed at the host bone–allograft junction. Complications included non‐union (16.2%), fractures (8.2%) and infections (11.8%). The incidence of complications was higher in the non‐compatible group; however, no significant relationship was found between HLA compatibility (or lack thereof) and the occurrence of complications. Conclusions Allografts are a good option for reconstruction after removal of larger tumors. It is necessary to take into account the mechanisms of incorporation and the measures that can be taken to reduce complications.