Long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade <b>Ⅲ</b> giant cell tumor_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Gang ¹ , LI Jiaqi ¹ , HUANG Junqi ¹ , WANG Tao ¹ , TANG Shitian ¹ , SHI Bo ¹ , HUANG Fuguo ² ,  WANG Jun ¹

1. Department of Orthopedics, Mianyang Central Hospital, Mianyang Sichuan, 621000, P.R.China;
2. Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

WANG Jun, Email: lendysa@163.com

Keywords：

Giant cell tumor; fibular graft; radiocarpal joint; functional reconstruction

DOI：

10.7507/1002-1892.201904117

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Objective To evaluate the long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor (GCT) of distal radius.Methods Between December 2010 and December 2014, 10 patients with Campanacci grade Ⅲ GCT of distal radius were treated with en bloc excision and inradiocarpal joint reconstruction using vascularized fibula flap. They were 6 males and 4 females, with an average age of 39.9 years (range, 22-65 years). The disease duration was 1.5-6.0 months (mean, 2.6 months). The length of distal radius defect was 6.0-12.5 cm (mean, 8.4 cm) after en bloc excision of GCT. Vascularized fibula flap with inferior lateral genicular vessels were performed in 6 patients and with inferior lateral genicular vessels and peroneal vessels in 4 cases.Results All incisions healed by first intention. All patients were followed up 4.4-8.3 years (mean, 6.0 years). There was no tumor recurrence during follow-up. At last follow-up, the mean ranges of motion of wrist joint were 55.0° (range, 25-85°) in extension, 26.5° (range, 15-40°) in flexion, 12.0° (range, 5-25°) in radial deviation, 19.6° (range, 10-30°) in ulnar deviation, 50.5° (range, 5-90°) in pronation, and 66.5° (range, 20-90°) in supination. The mean grip strength of effected wrist was 75% (range, 60%-85%) of the healthy wrist. The mean Musculoskeletal Tumor Society (MSTS) score was 82.7% (range, 75%-90%). X-ray films showed that the fibula flap healed at 12-16 weeks after operation (mean, 14.1 weeks) and there were 9 cases of radiological complications.Conclusion For Campanacci grade Ⅲ GCT of distal radius, application of the vascularized fibula flap in radiocarpal joint reconstruction after en bloc excision of GCT can obtain good wrist function.

Citation： LIU Gang, LI Jiaqi, HUANG Junqi, WANG Tao, TANG Shitian, SHI Bo, HUANG Fuguo, WANG Jun. Long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(3): 352-356. doi: 10.7507/1002-1892.201904117 Copy

1.	Zhang J, Li Y, Li D, et al. Clinical effects of three surgical approaches for a giant cell tumor of the distal radius and ulna. Mol Clin Oncol, 2016, 11(5): 613-617.
2.	Zou C, Lin T, Wang B, et al. Managements of giant cell tumor within the distal radius: a retrospective study of 58 cases from a single center. J Bone Oncol, 2019, 14(2): 1-8.
3.	Abuhejleh H, Wunder JS, Ferguson PC, et al. Extended intralesional curettage preferred over resection-arthrodesis for giant cell tumour of the distal radius. Eur J Orthop Surg Traumatol, 2019, 11(7): 1-7.
4.	吴苏稼, 施鑫, 周光新, 等. 复杂性骨巨细胞瘤的外科治疗初步随访分析. 中国修复重建外科杂志, 2006, 20(10): 1004-1006.
5.	Yang YF, Wang JW, Huang P, et al. Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor. BMC Musculoskelet Disord, 2016, 17(1): 346.
6.	Qi DW, Wang P, Ye ZM, et al. Clinical and radiographic results of reconstruction with fibular autograft for distal radius giant cell tumor. Orthop Surg, 2016, 8(2): 196-204.
7.	Luchetti TJ, Wysocki RW, Cohen MS. Distal radius allograft reconstruction utilizing a step-cut technique after en bloc tumor resection. Hand (N Y), 2019, 14(4): 530-533.
8.	Wang B, Wu Q, Liu J, et al. What are the functional results, complications, and outcomes of using a custom unipolar wrist hemiarthroplasty for treatment of grade Ⅲ giant cell tumors of the distal radius? Clin Orthop Relat Res, 2016, 474(12): 2583-2590.
9.	Vyas A, Patni P, Saini N, et al. Retrospective analysis of giant cell tumor lower end radius treated with en bloc excision and translocation of ulna. Indian J Orthop, 2018, 52(1): 10-14.
10.	Gulia A, Puri A, Prajapati A, et al. Outcomes of short segment distal radius resections and wrist fusion with iliac crest bone grafting for giant cell tumor. J Clin Orthop Trauma, 2019, 10(6): 1033-1037.
11.	Wang T, Chan CM, Yu F, et al. Does wrist arthrodesis with structural iliac crest bone graft after wide resection of distal radius giant cell tumor result in satisfactory function and local control? Clin Orthop Relat Res, 2017, 475(3): 767-775.
12.	Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg (Am), 1978, 60(6): 731-746.
13.	Sano K, Kimura K, Ozeki S. Vascularized iliac bone lining in downgraded treatment of campanacci grade Ⅲ giant cell tumor of the distal radius. J Hand Surg Asian Pac, 2018, 23(2): 255-258.
14.	Clarkson PW, Sandford K, Phillips AE. Functional results following vascularized versus nonvascularized bone grafts for wrist arthrodesis following excision of giant cell tumors. J Hand Surg (Am), 2013, 38(5): 935-940.
15.	Onoda S, Sakuraba M, Asano T, et al. Use of vascularized free fibular head grafts for upper limb oncologic reconstruction. Plast Reconstr Surg, 2011, 127(3): 1244-1253.
16.	江仁兵, 徐海, 白靖平, 等. 腓骨近端移植替代桡骨远端重建桡腕关节的临床解剖. 解剖学杂志, 2009, 32(4): 518-522.
17.	Innocenti M, Delcroix L, Manfrini M, et al. Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction. J Bone Joint Surg (Am), 2005, 87(Pt 1): 237-246.
18.	Usui M, Murakami T, Naito T, et al. Some problems in wrist reconstruction after tumor resection with vascularized fibular-head graft. J Reconstr Microsurg, 1996, 12(2): 81-88.
19.	Muramatsu K, Ihara K, Taguchi T. Treatment of giant cell tumor of long bones: clinical outcome and reconstructive strategy for lower and upper limbs. Orthopedics, 2009, 32(7): 491.
20.	朱忠胜, 张春林, 董扬, 等. 自体腓骨移植重建骨巨细胞瘤破坏的桡腕关节. 中国骨与关节杂志, 2012, 1(4): 335-339.
21.	Minami A, Kato H, Iwasaki N. Vascularized fibular graft after excision of giant-cell tumor of the distal radius: Wrist arthroplasty versus partial wrist arthrodesis. Plast Reconstr Surg, 2002, 110(1): 112-117.
22.	林佳生, 陈嵘, 严伟, 等. 经 Watson-Jones 入路动力髋螺钉内固定联合病灶刮除治疗股骨近端良性病变. 中国修复重建外科杂志, 2018, 32(1): 31-35.
23.	Saleh R, Yurianto H, Pasallo P, et al. Good functional outcome evaluation of free vascularized fibular head graft (FVFHG) as treatment after resection of giant cell tumor (GCT) campanacci 3 at proximal humerus: A case report. Int J Surg Case Rep, 2019, 61: 254-258.

1. Zhang J, Li Y, Li D, et al. Clinical effects of three surgical approaches for a giant cell tumor of the distal radius and ulna. Mol Clin Oncol, 2016, 11(5): 613-617.
2. Zou C, Lin T, Wang B, et al. Managements of giant cell tumor within the distal radius: a retrospective study of 58 cases from a single center. J Bone Oncol, 2019, 14(2): 1-8.
3. Abuhejleh H, Wunder JS, Ferguson PC, et al. Extended intralesional curettage preferred over resection-arthrodesis for giant cell tumour of the distal radius. Eur J Orthop Surg Traumatol, 2019, 11(7): 1-7.
4. 吴苏稼, 施鑫, 周光新, 等. 复杂性骨巨细胞瘤的外科治疗初步随访分析. 中国修复重建外科杂志, 2006, 20(10): 1004-1006.
5. Yang YF, Wang JW, Huang P, et al. Distal radius reconstruction with vascularized proximal fibular autograft after en-bloc resection of recurrent giant cell tumor. BMC Musculoskelet Disord, 2016, 17(1): 346.
6. Qi DW, Wang P, Ye ZM, et al. Clinical and radiographic results of reconstruction with fibular autograft for distal radius giant cell tumor. Orthop Surg, 2016, 8(2): 196-204.
7. Luchetti TJ, Wysocki RW, Cohen MS. Distal radius allograft reconstruction utilizing a step-cut technique after en bloc tumor resection. Hand (N Y), 2019, 14(4): 530-533.
8. Wang B, Wu Q, Liu J, et al. What are the functional results, complications, and outcomes of using a custom unipolar wrist hemiarthroplasty for treatment of grade Ⅲ giant cell tumors of the distal radius? Clin Orthop Relat Res, 2016, 474(12): 2583-2590.
9. Vyas A, Patni P, Saini N, et al. Retrospective analysis of giant cell tumor lower end radius treated with en bloc excision and translocation of ulna. Indian J Orthop, 2018, 52(1): 10-14.
10. Gulia A, Puri A, Prajapati A, et al. Outcomes of short segment distal radius resections and wrist fusion with iliac crest bone grafting for giant cell tumor. J Clin Orthop Trauma, 2019, 10(6): 1033-1037.
11. Wang T, Chan CM, Yu F, et al. Does wrist arthrodesis with structural iliac crest bone graft after wide resection of distal radius giant cell tumor result in satisfactory function and local control? Clin Orthop Relat Res, 2017, 475(3): 767-775.
12. Enneking WF, Dunham WK. Resection and reconstruction for primary neoplasms involving the innominate bone. J Bone Joint Surg (Am), 1978, 60(6): 731-746.
13. Sano K, Kimura K, Ozeki S. Vascularized iliac bone lining in downgraded treatment of campanacci grade Ⅲ giant cell tumor of the distal radius. J Hand Surg Asian Pac, 2018, 23(2): 255-258.
14. Clarkson PW, Sandford K, Phillips AE. Functional results following vascularized versus nonvascularized bone grafts for wrist arthrodesis following excision of giant cell tumors. J Hand Surg (Am), 2013, 38(5): 935-940.
15. Onoda S, Sakuraba M, Asano T, et al. Use of vascularized free fibular head grafts for upper limb oncologic reconstruction. Plast Reconstr Surg, 2011, 127(3): 1244-1253.
16. 江仁兵, 徐海, 白靖平, 等. 腓骨近端移植替代桡骨远端重建桡腕关节的临床解剖. 解剖学杂志, 2009, 32(4): 518-522.
17. Innocenti M, Delcroix L, Manfrini M, et al. Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction. J Bone Joint Surg (Am), 2005, 87(Pt 1): 237-246.
18. Usui M, Murakami T, Naito T, et al. Some problems in wrist reconstruction after tumor resection with vascularized fibular-head graft. J Reconstr Microsurg, 1996, 12(2): 81-88.
19. Muramatsu K, Ihara K, Taguchi T. Treatment of giant cell tumor of long bones: clinical outcome and reconstructive strategy for lower and upper limbs. Orthopedics, 2009, 32(7): 491.
20. 朱忠胜, 张春林, 董扬, 等. 自体腓骨移植重建骨巨细胞瘤破坏的桡腕关节. 中国骨与关节杂志, 2012, 1(4): 335-339.
21. Minami A, Kato H, Iwasaki N. Vascularized fibular graft after excision of giant-cell tumor of the distal radius: Wrist arthroplasty versus partial wrist arthrodesis. Plast Reconstr Surg, 2002, 110(1): 112-117.
22. 林佳生, 陈嵘, 严伟, 等. 经 Watson-Jones 入路动力髋螺钉内固定联合病灶刮除治疗股骨近端良性病变. 中国修复重建外科杂志, 2018, 32(1): 31-35.
23. Saleh R, Yurianto H, Pasallo P, et al. Good functional outcome evaluation of free vascularized fibular head graft (FVFHG) as treatment after resection of giant cell tumor (GCT) campanacci 3 at proximal humerus: A case report. Int J Surg Case Rep, 2019, 61: 254-258.

Chinese Journal of Reparative and Reconstructive Surgery

Long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor

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