Complications of massive allograft reconstruction for bone tumors

Background: since the evolution of multi-drug chemotherapy and radiotherapy and new sophisticated surgical techniques,limb salvage and reconstruction, rather than amputation, has become the preferred treatment for patients withbone tumors. one option is allograft replacement. although allograft has several advantages, it is not without complications. this study was performed to observe these complications in a group of patients treated with allograft replacementfor bone tumor resection. the purpose was to gain an overview of the factors predisposing to these complications tominimize their occurrence.methods: this retrospective study was performed on patients with benign aggressive and malignant bone tumors undergoinglimb reconstruction with allograft between 1997 and 2005 in ai-zahra and kashani hospitals in isfahan , iran.data was collected from patient files, clinical notes, radiographs and a recent physical examination. complications includinglocal recurrence, fracture of allograft, fixation failure, nonunion, infection, skin necrosis and neurological damagewere recorded.results: sixty patients including 39 males and 21 females were studied. the mean age of patients was 23 ± 11.7years. the mean follow-up interval was 28.1 ± 12.4 months (mean ± sd). complications were allograft fracture in20%, local recurrence in 16%, fixation failure in ii %, nonunion in 6%, infection in 6%, skin necrosis in 6%, and peronealnerve palsy in 1% of cases. most local recurrences (60%) were those with a mal-performed biopsy . most allograftfractures occurred when a short plate was used.conclusions: allograft replacement for bone tumors remains a valid option . to avoid complications, biopsy shouldbe done by a trained surgeon in bone oncology. a long plate is recommended for fixation. sterility and graft processingmust be optimal. autogenous bone graft must be added at host-allograft junction.