Clinical Study Intercalary Reconstruction after Wide Resection of Malignant Bone Tumors of the Lower Extremity Using a Composite Graft with a Devitalized Autograft and a Vascularized Fibula Koichi Ogura, 1 Shimpei Miyamoto, 2 Minoru Sakuraba, 2 Tomohiro Fujiwara, 1 Hirokazu Chuman, 1 and Akira Kawai 1 1 Department of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan 2 Department of Plastic and Reconstruction Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan Correspondence should be addressed to Akira Kawai; akawai@ncc.go.jp Received 29 November 2014; Revised 16 January 2015; Accepted 2 February 2015 Academic Editor: Valerae O. Lewis Copyright © 2015 Koichi Ogura et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Although several intercalary reconstructions ater resection of a lower extremity malignant bone tumor are reported, there are no optimal methods which can provide a long-term reconstruction with fewest complications. We present the outcome of reconstruction using a devitalized autograt and a vascularized ibula grat composite. Materials and Methods. We conducted a retrospective review of 11 patients (7 males, 4 females; median age 27 years) undergoing reconstruction using a devitalized autograt (pasteurization (=6), deep freezing (=5)) and a vascularized ibula grat composite for lower extremity malignant bone tumors (femur ( = 10), tibia (=1)). Results. he mean period required for callus formation and bone union was 4.4 months and 9.9 months, respectively. Four postoperative complications occurred in 3 patients: 2 infections (1 pasteurized autograt, 1 frozen autograt) and 1 fracture and 1 implant failure (both in pasteurized autograts). Grat removal was required in 2 patients with infections. he mean MSTS score was 81% at last follow-up. Conclusions. Although some complications were noted in early cases involving a pasteurized autograt, our novel method involving a combination of a frozen autograt with a vascularized ibula grat and rigid ixation with a locking plate may ofer better outcomes than previously reported allograts or devitalized autograts. 1. Introduction Limb salvage surgery has replaced amputation for malig- nant musculoskeletal tumors. Most bone sarcomas occur in the metaphyseal portion of the bone and typical resection involves the whole proximal or distal part of the bone. herefore, in most cases, the resected segment of bone is replaced by a prosthesis, which provides satisfactory results quickly ater surgery. However, when the tumor involves the diaphyseal portion of the bone, an intercalary reconstruction method is required, and this has not been standardized. Intercalary allograts, which is the most widely accepted reconstruction method, are associated with high incidences of nonunion (12–57%), fracture (17–30%), and infection (10–15%). [1–6]. In addition, single use of devitalized auto- grat such as frozen autograt or pasteurized autograt was also associated with nonunion (20% and 7%, resp.) [7, 8]. Although a segmental prosthesis can provide immediate stability and good short-term postoperative function, it is associated with long-term problems including implant wear, breakage, and loosening with the 10-year implant survival of 63% [9]. herefore there is an urgent need to develop an optimal reconstruction method for this type of condition. Vascularized ibula grats have been reported to yield favorable outcomes in terms of bone union in cases of trauma, infection, or musculoskeletal tumors [10–15]. Recently, sev- eral investigators have reported an intercalary reconstruction technique using a composite grat comprising a free vascular- ized ibula grat with an allograt, or an extracorporeally irra- diated or pasteurized autograt, in order to overcome short- comings such as nonunion, infection, and fracture resulting from deterioration of mechanical strength [10, 16–18]. he aim of the present study was to analyze the clinical and functional outcomes of intercalary reconstruction using Hindawi Publishing Corporation Sarcoma Volume 2015, Article ID 861575, 8 pages http://dx.doi.org/10.1155/2015/861575