Vascularized bone grafts for post-traumatic defects in the upper extremity

 

 Permissions and Reprints

Vascularized bone grafts (VBGs) are widely employed to reconstruct upper extremity bone defects. Conventional bone grafting is generally used to treat defects smaller than 5–6 cm, when tissue vascularization is adequate and there is no infection risk. Vascularized fibular grafts (VFGs) are mainly used in the humerus, radius or ulna in cases of persistent non-union where traditional bone grafting has failed or for bone defects larger than 6 cm. Furthermore, VFGs are considered to be the standard treatment for large bone defects located in the radius, ulna and humerus and enable the reconstruction of soft-tissue loss, as VFGs can be harvested as osteocutaneous flaps. VBGs enable one-stage surgical reconstruction and are highly infection-resistant because of their autonomous vascularization. A vascularized medial femoral condyle (VFMC) free flap can be used to treat small defects and non-unions in the upper extremity. Relative contraindications to these procedures are diabetes, immunosuppression, chronic infections, alcohol, tobacco, drug abuse and obesity. The aim of our study was to illustrate the use of VFGs to treat large post-traumatic bone defects and osteomyelitis located in the upper extremity. Moreover, the use of VFMC autografts is presented.

This article was presented at the 36th Scientific Meeting of the Korean Society for Microsurgery on October 28, 2017, in Seoul, Korea.

The authors thank Marisa Mancini, medical illustrator and photographer, for her valuable support in the illustrations and digital content. All the photos and drawings are her own creation.

Publication History

Received: 19 May 2020

Accepted: 29 September 2020

Article published online:
20 March 2022

© 2021. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

• REFERENCES

• 1 Klifto CS, Gandi SD, Sapienza A. Bone graft options in upper-extremity surgery. J Hand Surg Am 2018; 43: 755-61
  CrossrefPubMedGoogle Scholar
• 2 Khan SN, Cammisa Jr FP, Sandhu HS. et al. The biology of bone grafting. J Am Acad Orthop Surg 2005; 13: 77-86
  CrossrefPubMedGoogle Scholar
• 3 Taylor GI, Miller GD, Ham FJ. The free vascularized bone graft: a clinical extension of microvascular techniques. Plast Reconstr Surg 1975; 55: 533-44
  CrossrefPubMedGoogle Scholar
• 4 Adani R, Delcroix L, Innocenti M. et al. Reconstruction of large posttraumatic skeletal defects of the forearm by vascularized free fibular graft. Microsurgery 2004; 24: 423-9
  CrossrefPubMedGoogle Scholar
• 5 Safoury Y. Free vascularized fibula for the treatment of traumatic bone defects and nonunion of the forearm bones. J Hand Surg Br 2005; 30: 67-72
  CrossrefPubMedGoogle Scholar
• 6 Adani R, Delcroix L, Tarallo L. et al. Reconstruction of posttraumatic bone defects of the humerus with vascularized fibular graft. J Shoulder Elbow Surg 2008; 17: 578-84
  CrossrefPubMedGoogle Scholar
• 7 Chhabra AB, Golish SR, Pannunzio ME. et al. Treatment of chronic nonunions of the humerus with free vascularized fibula transfer: a report of thirteen cases. J Reconstr Microsurg 2009; 25: 117-24
  Article in Thieme ConnectPubMedGoogle Scholar
• 8 Noaman HH. Management of upper limb bone defects using free vascularized osteoseptocutaneous fibular bone graft. Ann Plast Surg 2013; 71: 503-9
  CrossrefPubMedGoogle Scholar
• 9 Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg 1991; 87: 290-8
  CrossrefPubMedGoogle Scholar
• 10 Burger HK, Windhofer C, Gaggl AJ. et al. Vascularized medial femoral trochlea osteocartilaginous flap reconstruction of proximal pole scaphoid nonunions. J Hand Surg Am 2013; 38: 690-700
  CrossrefPubMedGoogle Scholar
• 11 Toros T, Ozaksar K. Reconstruction of traumatic tubular bone defects using vascularized fibular graft. Injury 2019 Aug 14 [Epub]. DOI: 10.1016/j.injury.2019.08.013.
  CrossrefPubMedGoogle Scholar
• 12 Arai K, Toh S, Tsubo K. et al. Complications of vascularized fibula graft for reconstruction of long bones. Plast Reconstr Surg 2002; 109: 2301-6
  CrossrefPubMedGoogle Scholar
• 13 Malizos KN, Fyllos A, Varytimidis S. et al. Tips to secure healing at the free vascularised fibular graft-to-host bone junction. Injury 2019; 50 Suppl 5: S46-9
  CrossrefPubMedGoogle Scholar
• 14 Bakri K, Shin AY, Moran SL. The vascularized medial femoral corticoperiosteal flap for reconstruction of bony defects within the upper and lower extremities. Semin Plast Surg 2008; 22: 228-33
  Article in Thieme ConnectPubMedGoogle Scholar
• 15 Kakar S, Duymaz A, Steinmann S. et al. Vascularized medial femoral condyle corticoperiosteal flaps for the treatment of recalcitrant humeral nonunions. Microsurgery 2011; 31: 85-92
  CrossrefPubMedGoogle Scholar
• 16 Rodriguez-Vegas JM, Delgado-Serrano PJ. Corticoperiosteal flap in the treatment of nonunions and small bone gaps: technical details and expanding possibilities. J Plast Reconstr Aesthet Surg 2011; 64: 515-27
  CrossrefPubMedGoogle Scholar
• 17 Choudry UH, Bakri K, Moran SL. et al. The vascularized medial femoral condyle periosteal bone flap for the treatment of recalcitrant bony nonunions. Ann Plast Surg 2008; 60: 174-80
  CrossrefPubMedGoogle Scholar