Free vascularized bone transfer in limb salvage surgery of the upper extremity

Salvage of the upper extremity following tumor resection may require reconstruction of massive bone defects. This more commonly results from malignant bone tumors, but defects requiring reconstruction also may occur following resection of locally aggressive benign tumors. Examples include osteosarcoma, chondrosarcoma, Ewing sarcoma, giant cell tumor, and certain soft tissue sarcomas invading bone. Obtaining satisfactory results using conventional bone grafting techniques is at best challenging when defects of substantial size are encountered. Free vascularized bone grafting procedures provide the appealing option of transferring living bone based on a vascular pedicle.