Cell and Tissue Banking 4: 125–132, 2003. 125 © 2003 Kluwer Academic Publishers. Printed in the Netherlands. The use of irradiated allografts in reconstruction of tumor defects – the Tata Memorial Hospital experience A. Lobo Gajiwala 1,∗ , M. Agarwal 2 , A. Puri 2 , C. D’Lima 1 & A. Duggal 2 1 Tissue Bank, 2 Department of Orthopaedic Oncology, Tata Memorial Hospital, Parel, Mumbai 400 012, India ∗ Author for correspondence (Tel.: 91-022-24177112; Fax: 91-022-4146937; e-mail: lobogajiwalaa@tmcmail.org and asklobog@vsnl.com) Key words: lyophilised, irradiated allografts, morsellised, struts, tumour reconstruction Abstract A Tissue Bank is a valuable adjunct to tumour management. In bone tumours, the defects produced by ablative surgery can be reconstructed using banked tissue, thereby obviating the donor site morbidity associated with autografts. Allografts are especially useful in large defects or in children where the quantity of available autograft is limited. The use of bone allografts in India has been limited by the availability of good quality, affordable grafts. In this article we share our experience with the use of indigenously produced allografts in limb salvage, as bone graft expanders and as struts. Lyophilised, irradiated bone allografts were morcellised and used in 32 patients. In 21 of these patients the allograft was used in contained cavities. Complete incorporation of the graft was seen between 6–9 months in all the 25 cases available for follow-up. In 4 patients the allograft was layered onto autograft. The allograft incorporated with the host bone in only one of these patients. Struts were used in 9 cases (3 cases complete intercalary segmental defect, 3 cases of hemicortical defects, 2 cases of allograft-prosthesis composite around the hip, 1 case an iliac-crest block was used to stop bleeding from an anterior sacral defect). Of these, no incorporation of the full segment struts was observed in 2 patients who were on chemotherapy and radiotherapy. The sacral defect case was lost to follow-up. All the other struts incorporated with the host bone within 6–9 months. In 5 cases there was sterile postoperative drainage. Overall infection was observed in 4 patients (10%). In one the graft was removed, another settled uneventfully with subsequent incorporation of graft, and two have a persisting sinus but good incorporation. Since radiation and lyophilisation are known to affect the material properties of bone, the grafts were rehydrated in saline for 30 minutes prior to transplantation. Autogenous marrow or autograft was used to provide osteoinductive properties. In selected cases the lyophilised, irradiated bone allografts proved to be clinically useful in the reconstruction of large tumour defects. Introduction Bone grafting is one of the most frequent operations performed. Autografts remain the gold standard as they are osteoconductive as well as osteoinductive and have osteogenic cells. Most of the time, the amount of graft required is small and harvesting bone from the iliac crest or the fibula suffices. This however, requires an additional incision, increasing operating time, blood loss as well as costs. With time it has become evident that there is also a significant mor- bidity related to the donor site. Major complications, such as cutaneous nerve damage, chronic donor site pain, vascular injury, infection, and iliac fracture, have been reported in approximately 10–25% of patients (Fernybough et al.; Banwart et al.; Kreibich et al. 1994; Lim et al. 1996; Cockin 1971; Laurie et al. 1984; Summers and Eisenstein 1989). This morbid- ity is in direct proportion to the quantity of graft retrieved.