Pediatric limb salvage: Team approach to orthopedic oncology

Mayo Clinic's team approach to treatment of pediatric long bone sarcomas allows for full oncologic resection while preserving limb function. Specialists in orthopedic and radiation oncology, pediatric oncology, pediatric orthopedic surgery, and plastic surgery work together to treat children who need complex tumor surgery.

"We have a complete team that works to cure the child of cancer and give the child a functional extremity. Once these kids have healed, a lot of them go back to doing the things that kids do. We've had kids return to playing high school football and volleyball," says Matthew T. Houdek, M.D., an orthopedic oncologist at Mayo Clinic in Rochester, Minnesota.

Care for children with long bone sarcomas starts with pediatric oncology and generally includes chemotherapy. Advanced MRI and CT imaging help Mayo Clinic surgeons plan complex procedures that can last up to 12 hours. Typically, Dr. Houdek resects the tumor in conjunction with Steven L. Moran, M.D., a plastic surgeon who performs vascularized free fibula transfer, and Anthony A. Stans, M.D., a pediatric orthopedic surgeon who performs the structural allograft reconstruction and compression plate fixation.

"The use of vascularized fibula graft has significantly improved outcomes for these patients," Dr. Houdek says.

The free vascularized fibula transfers combined with structural allograft reconstructions that are performed at Mayo Clinic for limb salvage following oncologic resection in pediatric patients are known as the "Capanna Technique." In a review published in the March 2016 issue of Clinical Orthopaedics and Related Research, Dr. Houdek and colleagues found that the procedure provided a successful means of limb salvage with an acceptable complication rate.

"It's common for patients to have post-surgical chemotherapy, and that treatment makes it substantially more likely that a first-time union will fail," Dr. Houdek says. "We try to lessen that risk by utilizing compression plating and a free vascularized fibular graft. Although this adds time to the case, we feel it is important since it will improve the long-term functional outcome of the children."

"That's why it's so important to have an expert care team," he adds. "Mayo Clinic is the ideal center because we work as one big team to take care of these kids."

For more information

Houdek MT, et al. What is the outcome of allograft and intramedullary free fibula (Capanna Technique) in pediatric and adolescent patients with bone tumors? Clinical Orthopaedics and Related Research. 2016;474:660.