Dolph Houben

66 CHAPTER 3 Figure 5: average MSTS score: calculated means are represented by the blue squares Time to Full Weight Bearing Nine studies described the average time to full weight bearing in 135 cases. The average time to full weight bearing in these studies was 11.28 months (95% CI: 7.99 to 14.6). Amputation and recurrence The oncologic studies reported 19 amputations in 331 reconstructions. These amputations were the result of local tumor recurrence or a severe deep infection or sepsis. A total of 21 reoccurring tumors have been reported and 23 cases of metastatic disease. Seventeen cases died from metastatic disease. Discussion Limb-sparing surgery has become important in the treatment of oncological and traumatic patients to improve their functional outcome [13, 14] . In long bone sarcoma patients 85-90 percent are candidates for limb-sparing surgery [1] . With the growing numbers of cases treated with limb- sparing surgery, a wide variety of reconstructive techniques for large bony defects has been described in literature. Massive structural allografts have been most frequently used for limb reconstruction but are associated with complications as allograft fracture, infection, and non- union due to the avascular nature of the graft [13-15, 32] . The Capanna technique was developed to add biological activity to the reconstruction to reduce these complications and induce revascularization of the allograft. The first reconstruction of an intercalary resection of the tibia with a combination of an external massive allograft a free vascularized contralateral fibular flap was done in 1989 [24] .