Figure 10
From: Bone Regeneration Based on Tissue Engineering Conceptions — A 21st Century Perspective
The vascularised fibula transfer is one of the most commonly used techniques for reconstruction of large tibial defects in orthopaedic oncology. The figure shows clinical case from a 16 year old girl with a malignant tumour of the mid-shaft of tibia. A: Xray showing destructive lesion. B: Segmental resection of tumour. C: Defect created by the removal of tumour. D: Example of reconstruction using vascularised fibular within allograft bone (Cappanna procedure). E: Reconstruction in-situ using vascularised fibular and allograft. F: postoperative X-ray images. G: 3D computed tomogram of reconstruction showing fibula enclosed by allograft bone material (Clinical case: P.F.C.). A novel biological approach to avoid the use of allograft material could be the combination of a vascularised fibula transfer with a custom made tissue engingeering construct as shown in H: After resection of the malignant tumour (1), a customized tubular scaffold is placed around the vascularised fibula autograft to fill the defect (2,3). Primary stability and even load distribution is achieved by using an internal fixation device (4). Secondary stability is achieved by osseointegration of both the fibula and the porous tissue engineering scaffold. Over time, the scaffold is slowly replaced by ingrowing tissue engineered bone and the defect is completely bridged and regenerated (5). H partly reproduced with permission from (246), © The Authors.
