Complex Biological Reconstruction after Wide Excision of Osteogenic Sarcoma in Lower Extremities

Wide margin resection of extremity tumor sometimes leaves a huge soft tissue and bony defects in limb salvage surgery. Adequate management of these defects is an absolute requirement when aiming for functional limb. Multidisciplinary management in such cases is an answer when complex biologic reconstruction is desired. We aim to present cases of osteogenic sarcoma of lower extremity requiring combined surgical approach to achieve effective musculoskeletal reconstruction. Patients and Methods. From 2006 to 2010 ten patients were operated on for osteogenic sarcoma of lower extremity requiring complex musculoskeletal reconstruction. Results. Six patients had pathology around knee joint, whereas one each with mid tibia, mid femur, proximal femur, and heel bone. Locking compression plate was used in 7 patients including six with periarticular disease. Eight out of ten patients underwent biologic reconstruction using autograft; endoprosthetic reconstruction and hindquarter amputation were done in the remaining two patients. Vascularized fibula was done in five patients, sural artery flap which was primarily done in three patients, spare part fillet flap, free iliac crest flap, and Gastrocnemius flap was done in one patient each. Secondary hemorrhage, infection, nonunion, wound dehiscence, and flap failure were notable complications in four patients. The Average Musculoskeletal Tumor Society score was 89%. Conclusion. Combined surgical approach results in cosmetically acceptable and functional limb. 1. Introduction Osteogenic sarcoma is the most common primary malignant bone tumor in children and adolescents. Historically, more radical treatment options were employed in the management of these tumors in the form of amputation or disarticulations. With advances in multidisciplinary approach toward management, over 90% are limb preserving surgeries. Options for limb salvage reconstruction after wide resection include osteoarticular allograft, allograft prosthetic composite, recycled autograft, and modular or custom made endoprosthesis [1–3]. Due to financial constraints, biologic reconstruction with recycled autograft is common in our part of the world. The long-term result in terms of joint range of motion (ROM) is as good as endoprosthetic reconstruction. However, it requires immobilization during immediate postoperatively till the time of union. Conventionally, wide margin resection is an absolute requirement to ensure adequate resection in order to decrease the risk of disease recurrence. However with recent advances in surgical oncology, more conservative