Biological Reconstructions After Tumor Resection

How to reconstruct a large bone defect is a demanding situation for orthopedic surgeons. Allografts have been used for several decades as an alternative. However, high complications rates originated the idea of an unpredictable nature of allografts. In recent years, reports of large series of patients with long-term follow-up support higher expectation for the use of allografts in orthopedic oncology surgery and have made it possible to clarify the results and indications. There have been improvements in the knowledge of biology of allograft incorporation. However, implications of immune responses in clinical practice remain obscure. Different types of allografts and anatomic locations show different clinical outcomes being proximal tibia osteoarticular allografts those with worse results. Precise surgical techniques improve the results and allograft’s survival. Major complications can be treated successfully, preserving the graft, with a retransplant or with other reconstructive procedure. Accuracy of bone selection and tumor and allograft navigation in selected anatomical areas offers better outcomes. After several decades of basic and clinical research, a better understanding of allograft makes them more predictable. Probably, until future viable bioengineered composite multitissue components become available in clinical practice, bone-stored allograft with additional improvements will have a place.