Does Resection Length Dictate Reconstruction Type? Systematic Review of Biological Reconstruction Methods After Oncologic Intercalary Resection in Children and Young Adults

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Abstract

Limb salvage surgery is the preferred treatment for pediatric bone tumors in the lower extremity when free margins can be achieved, particularly when adjacent joints can be preserved. Nevertheless, intercalary bone defects remain challenging. Common bio-logical reconstruction techniques include massive allograft, free vascularized fibular graft (FVFG), and the Capanna Technique (allograft combined with FVFG). This review summarizes current evidence on the proportion of complications associated with these techniques, with emphasis on non-union in relation to defect length. Finally, we propose directions for future research to refine patient selection for biological reconstruction. A systematic review was conducted using PubMed, Scopus, Embase, and Cochrane Library. Eligible studies reported outcomes of allograft, FVFG, or the Capanna technique for intercalary lower limb reconstruction in children or adolescents and reported on defect length. Fourteen articles met the inclusion criteria: two on allograft, two on FVFG, and ten on the Capanna technique. In total, 181 patients were included (allograft: 17, FVFG: 16, Capanna: 148 patients). Mean defect lengths were 15.5 cm (allograft), 11.4 cm (FVFG), and 15.0 cm (Capanna). Average union times were longest with allograft (15.5 months) and shortest with FVFG and Capanna (11.4 and 11.6 months). The Capanna technique demonstrated the lowest non-union proportion (16.5%), compared with FVFG (25%); non-union data of the allograft were inconsistently reported. Fractures and infections were least common in the Capanna group. The reconstruction strategy should be tailored to defect size, anatomical location, and patient-specific factors. The Capanna technique appears most favorable for larger defects in the lower extremities, but its potential role in smaller defects warrants further investigation.

Authors 6

1. Whitney L. Kenswiel

   University Medical Center Utrecht

   Affiliation as printed

   Division of Surgical Specialties , University Medical Center Utrecht , 3D Lab , 3584 CX Utrecht , The Netherlands

2. Lorenz H.M. van Schalkwijk

   Princess Máxima Center

   Affiliation as printed

   Princess Máxima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands

3. H. Chien Nguyen

   University Medical Center Utrecht

   Affiliation as printed

   Division of Surgical Specialties , University Medical Center Utrecht , 3D Lab , 3584 CX Utrecht , The Netherlands

4. Michiel A. J. van de Sande Aachen Department of Orthopedic Surgery

   Leiden University Medical Center · Princess Máxima Center

   Affiliation as printed

   Department of Orthopedic Surgery , Leiden University Medical Center , 2333 ZA Leiden , The Netherlands

   Princess Máxima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands

5. Lizz van der Heijden corresponding

   Princess Máxima Center

   Affiliation as printed

   Princess Máxima Center for Pediatric Oncology , 3584 CS Utrecht , The Netherlands

6. David D. Krijgh

   University Medical Center Utrecht

   Affiliation as printed

   Department of Plastic and Reconstructive Surgery , University Medical Center Utrecht , 3508 GA Utrecht , the Netherlands