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Intercalary Bone Grafts for Joint and Limb Preservation in dogs with malignant bone tumors
Malignant bone tumors, especially osteosarcomas, are common in large or giant breeds and mainly affect the diaphysis. Although several therapeutic regimen exist, the prognosis remains guarded and most protocols recommend radical amputation of the limb. This brand new surgical technique offers promising therapeutic alternatives - without amputation.

Seventeen client-owned dogs with highly malignant bone tumors of the diaphysis were included in this retrospective study.

The bone tumor database and medical records were reviewed (19862002) for dogs with diaphyseal tumors treated with intercalary resection and reconstruction with either an allograft or irradiated autograft.
Clinical presentation, diagnostic findings, surgical management, and outcome were determined from medical records and telephone interviews with veterinarians and owners.
Statistical analyses included Chi2 to test associations between intra- and postoperative variables with complications, and KaplanMeier survival analysis for disease-free interval, metastasis-free interval (MFI), and median survival time.

Results: Intercalary limb-sparing surgery was performed in 17 dogs with diaphyseal tumors: osteosarcoma (OSA) (15), histiocytic sarcoma (1), and solitary metastasis from a pulmonary adenocarcinoma (1).
One dog was excluded from further analysis when the spared limb was amputated 4 days postoperatively because of incomplete tumor resection.

In 16 dogs, limb function was good to excellent. Complications occurred in 5 dogs (31.3%) and included superficial infection in 2 dogs (12.5%) and implant failure in 4 dogs (25%).

All implant failures occurred in the ulna and there was a significant association between implant failure and non-cemented allografts (P=.042). Non-union of 1 or both osteotomies was diagnosed in 10 dogs (83.3%) and, despite lack of clinical signs in all cases, was significantly associated with the use of intracavitary locally released cisplatin (P=.046) and cemented intercalary grafts (P=.046).

Local tumor recurrence was diagnosed in 1 dog (6.3%) and metastatic disease in 12 dogs (75.0%), including 10 dogs with OSA. The median MFI was 137 days.

The local disease-free and overall limb-salvage rate was 94% and 100%, respectively. Overall median survival time was 393 days and the median survival time for dogs with OSA was 449 days.

Conclusion: Intercalary limb-sparing surgery results in better postoperative limb function with fewer and less severe complications than historical reports of dogs treated with non-intercalary limb-sparing surgery.
In dogs with diaphyseal tumors, intercalary limb-sparing surgery preserves normal joint function and results in good to excellent limb use with few complications and good local tumor control.

Source: Liptak, Julius M., Dernell, William S., Straw, Rodney C., Jameson, Vicki J., Lafferty, Mary H., Rizzo, Scott A. & Withrow, Stephen J. (2004) :Intercalary Bone Grafts for Joint and Limb Preservation in 17 Dogs with High-Grade Malignant Tumors of the Diaphysis. In: Veterinary Surgery 33 (5), 457-467.




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