Methods of biological reconstruction for bone sarcoma: indications and limits

Therapy of bone sarcoma has dramatically changed over the past few decades. Several successful interdisciplinary treatment strategies have led to an increase of the survival rates from 20% to 60%-80%. Consequently new demands on the operative treatment of bone and soft tissue sarcoma have arisen. Nowadays limb salvage can be achieved in 80%-90% using tumour megaprostheses or biological reconstruction procedures. In this article we outline the indications and limitations of biological reconstruction procedures after bone tumour resection. We therefore introduce the different biological approaches such as free autologous bone grafting, reimplantation of extracorporeal devitalized autografts or distraction osteogenesis and summarize the currently available data on the individual procedures. Our analyses demonstrate a wide applicability of biological procedures in tumour situations. Although accompanied by considerable complications in the early postoperative phase, biological reconstructions clearly demonstrate the potential of having excellent long-term durability and functionality.