Page 48 - Read Online

Page 6 of 12 Wee et al. Plast Aesthet Res 2019;6:12 I http://dx.doi.org/10.20517/2347-9264.2019.02

Figure 5. Fixation of free fibula flap to reconstruct bony defect after resection of a left humerus chondrosarcoma

Figure 6. Radiograph showing extensive nature of humerus chondrosarcoma

allograft’s medullary canal, partially within the canal, or alongside the allograft as an onlay [13-15] . Here, we
chose to place the VBG partially within the medullary canal, inside a trough created through the bony cortex.
VBGs are at risk for early fracture and thus require immobilization, sometimes for over a year depending
on the anatomic location of reconstruction and rate of bony hypertrophy; the use of allograft contributes to
early postoperative stability by bearing the load of bony fixation. In turn, VBGs provide osteogenic factors
that allografts lack. This technique has been described in immediate and in delayed settings after resection
with equivalent rates of union; this versatility allows for definitive reconstruction to be delayed to confirm
surgical margins when they are in doubt . While originally described for reconstruction after tumor
[16]
resection, surgeons are beginning to use the Capanna technique in specific traumatic settings when risk for
infection is low .
[15]
Case 5. A 63-year-old morbidly obese male with history of diabetes and chondrosarcoma of the femur
presented with femur nonunion after he underwent neoadjuvant chemoradiation, tumor resection, and prior
allograft placement complicated by infection and nonunion of the proximal allograft abutment [Figure 8A].
He required cane assistance in ambulation to reduce potential for hardware failure given his nonunion and
body habitus. After a series of antibiotic nail exchanges, washouts, six months of negative microbacterial