In the JournalsPerspective

Capanna technique for intercalary reconstruction had high success rate

Patients who underwent the Capanna technique for intercalary reconstruction after tumor resection had a lower complication rate and higher success rate compared with use of an allograft or a vascularized fibular graft alone, according to published results.

Researchers performed a multivariable linear, multiple regression model analysis for 60 patients who underwent segmental reconstruction with use of the Capanna technique following tumor resection in which allograft-host osseous union time was the dependent variable. Researchers evaluated radiographs for union time and histologically assessed a retrieved specimen of the composite. Age, tumor site, adjuvant treatment, a previous surgical procedure, defect length, fixation method and fibular viability were considered independent variables.

Results showed patients had a mean defect length of 16 cm and union occurred among all allografts and host bone at a mean time to union of 13 months. Although devitalization of the fibular graft, use of chemotherapy and a previous surgical procedure were associated with prolonged time to union, researchers found no association between union time and patient age, amount of resection, operative site and fixation method. Histological analysis showed callus from both periosteum of the host bone and the fibula united the allograft-host cortical junction.

“Patients with adverse factors should be closely observed during the healing process; in such a scenario, extended immobilization and delayed weight-bearing are advised,” the authors wrote. “In most cases, osseous union still could be achieved even in the presence of those adverse factors.” – by Casey Tingle

Disclosures: The authors report no relevant financial disclosures.

Patients who underwent the Capanna technique for intercalary reconstruction after tumor resection had a lower complication rate and higher success rate compared with use of an allograft or a vascularized fibular graft alone, according to published results.

Researchers performed a multivariable linear, multiple regression model analysis for 60 patients who underwent segmental reconstruction with use of the Capanna technique following tumor resection in which allograft-host osseous union time was the dependent variable. Researchers evaluated radiographs for union time and histologically assessed a retrieved specimen of the composite. Age, tumor site, adjuvant treatment, a previous surgical procedure, defect length, fixation method and fibular viability were considered independent variables.

Results showed patients had a mean defect length of 16 cm and union occurred among all allografts and host bone at a mean time to union of 13 months. Although devitalization of the fibular graft, use of chemotherapy and a previous surgical procedure were associated with prolonged time to union, researchers found no association between union time and patient age, amount of resection, operative site and fixation method. Histological analysis showed callus from both periosteum of the host bone and the fibula united the allograft-host cortical junction.

“Patients with adverse factors should be closely observed during the healing process; in such a scenario, extended immobilization and delayed weight-bearing are advised,” the authors wrote. “In most cases, osseous union still could be achieved even in the presence of those adverse factors.” – by Casey Tingle

Disclosures: The authors report no relevant financial disclosures.

    Perspective

    Reconstructive surgeons are often faced with large segmental defects following bony oncologic extirpation. Historically, reconstruction of intercalary defects was performed with a structural allograft, endoprosthesis or a vascularized fibula flap. Rodolfo Capanna, MD, and his group combined the biomechanical support of a structural bulk allograft with the biological properties of the vascularized fibula flap to create a “living” allograft. Since its development, this technique has gained international acceptance as a reliable option to reconstruct intercalary bony defects. In addition, other centers have utilized this technique with treated (irradiated or frozen) structural autograft with similar results.

    The article by Jing Li, MD, PhD, and colleagues highlights the advantage of adding the fibula. The authors found that if the fibula heals to the host bone, the allograft will also reliably heal. This was shown histologically with the fibula first healing internally to the host bone, providing a biological strut, allowing the allograft to heal externally. This allows for reliable union of the host/allograft junction, even in the setting of chemotherapy. This article provides further support that although the vascularized fibula adds time to the reconstruction, the low incidence of construct failure outweighs the added time and remains our preferred technique for reconstruction in these patients.

    • Matthew T. Houdek, MD
    • Orthopedic surgeon
      Assistant professor of orthopedics
      Mayo Clinic
      Rochester, Minnesota

    Disclosures: Houdek reports no relevant financial disclosures.