Biological reconstruction for massive bone defect following resection of tumor in Japan.

Abstract

Several procedures of biological reconstruction for massive bone defect are available following tumor resection. Since the 1980s, allografting has been advanced mainly in the United States. However, allogeneic bone grafting has not been sufficiently developed in Japan for socioreligious reasons, and many other biological reconstructive methods have been developed. Bone lengthening, recycled and vascularized bone grafting have yielded favorable outcomes. Once bone union is achieved, reoperation is scarcely performed, with lower rate of infection than that observed with a prosthesis. However, there are disadvantages, such as complicated surgical procedures and relatively common postoperative complications. However, if sufficient donors are available, allogeneic bone grafting can be a good alternative. Regenerative medicine with iPS cells, etc., which is under investigation, is expected to be employed for defect reconstruction. However, several biological reconstructive procedures should be further developed. These procedures are not inferior to prosthetic and allograft reconstructions in the short term, but rather are superior in the long term. Favorable outcomes are being obtained by combining recycled bone reconstruction and vascularized bone grafting, suggesting possible improvement in the future. Data should be accumulated to develop biological reconstruction in Japan. Although Japan has the challenge in terms of the ability to convey its message, the disadvantages of the procedures should be minimized. The construction of an allogeneic bone grafting system should be promoted, while biological reconstruction methods developed in Japan should be further developed and convey our message clearly and logically.