Infection of massive bone allografts

A retrospective analysis of 75 consecutive cases of massive allograft implantations performed from July 1976 to October 1986 was conducted. Seventy percent of these patients had malignant bone tumors. Of the total group, 10 (13.3%) patients developed a deep infection of the allograft and are the subject of this review. Followup averaged 6.3 years from the time of infection onset. Final results were evaluated with a revised Mankin classification. Seventy percent of infections occurred within 1 month of the initial surgery. Polymicrobial infections were present in 50%. Wound and soft tissue complications were found to be the major predisposing risk factors for infection. Chemotherapy was not a statistically significant risk factor using Chi-square analysis. All allografts eventually had to be completely removed to control the infection. Limb salvage was possible in 7 patients, but 3 patients required an amputation. Two of the 3 amputations were performed for infection control, and 1 was performed for tumor recurrence with concurrent infection. Two allografts were salvaged with vascularized free fibula transfers. Two patients had implantation of a second allograft, which also became infected. Three patients required no further reconstruction. Results were: Excellent--2, Good--1, Fair--4, and Poor--3. Soft tissue coverage is of utmost importance in massive allograft procedures and should be ensured with local or free flaps, if necessary.