The reconstruction of large bone defects in the upper limb
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Updated: May 14, 2026

Vascularized Composite Upper Limb Allograft Harvesting for Proximal Arm Allotransplantation
Published on: June 13, 2025
Aaron W T Gan1, Mark E Puhaindran1, Robert W H Pho1
1Department of Hand & Reconstructive Microsurgery, National University Hospital, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore 119228, Singapore.
Abstract:
Large bone defects in the upper limb pose many challenges in reconstructive surgery. Conventional and innovative methods have been described, employing the use of microsurgical and non-microsurgical techniques to overcome both bony and soft tissue defects. This article reviews the success and pitfalls of different techniques of reconstruction of large bone defects in the upper limb, including microsurgical transfer of the free vascularised fibula graft as a diaphyseal bone replacement and as a hemivascularised joint transplant, and non-microsurgical options using conventional bone grafting, the induced membrane technique and the role of callotatic distraction-lengthening procedures.
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