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Reconstructive Surgery

Sometimes reconstructive surgery is needed to reshape or rebuild a part of the body changed by previous surgery. There are three main options for reconstructive surgery.

• Autogenous bone grafts-(where the bone material comes from your own body)
• Structural bone allografts-(where the bone comes from another individual)
• Metallic endoprosthetics

All three procedures have advantages and disadvantages and the choice depends on your age and the location of the tumor.

Autogenous bone grafts can be nonvascularized autografts, meaning the bone does not contain any blood vessels. They can come from your pelvis or other sites, and may be used for small defects. Autogenous bone grafts can also be vascularized grafts, meaning the bone contains blood vessels. They can be taken from the fibula (lower leg bone). Both forms of autografts have a high success rate because your body recognizes the new material and won't try to fight it off. A big disadvantage for using either nonvascularized or vascularized forms of autogenous bone grafts is that the area where the donated bone was taken from may be damaged, causing pain in this area and a longer healing time.

Structural bone allografts are taken from someone else, so you don't have to worry about damaging your own healthy bone. However there is some difficulty of the grafted bone correctly fusing to the host bone because your body might not recognize the new bone and might want to fight it off. This could lead to fractures. However, if they heal correctly and don't fracture, it may last a lifetime. Infection can occur in 10-15% of allograft reconstructions, and often requires the graft to be removed. In 10-25 % the bone does not heal correctly and requires additional surgery.

Metallic endoprosthetics are metal implants used in place of bone. They are good because they provide immediate and stable reconstruction and support. There are also expandable prosthetics, so that as you grow you can continue to use the same prostheses. However, they eventually can fail due to loosening or a breakdown of parts. Also, infections can be a risk with endoprostheses, with rates ranging from 0-35%.

The choice of the procedure depends on the location of the tumor removed and your age. Some treatments are limited in young patients who are still growing. Large structural allografts and endoprosthetics should not be done in children under 8 years of age.