Posttraumatic lower extremity reconstruction by vascularized bone graft transfer

Fourteen cases of vascularized bone transfer in the lower extremity for reconstruction of extensive bony defects are reviewed. Followup ranges from nine to 62 months. Donor sites include iliac crest in ten cases, fibula in two cases, rib in one case, and radius-ulna in one case. The indication for the procedure was reconstruction of an extensive bony defect after osteomyelitis in seven cases, acute trauma in five cases, chronic nonunion in one case, and a composite physis reconstruction in one case. In 13 (93%) of the 14 cases, success was ultimately achieved; however, six cases required a second operation. We conclude that this procedure is very valuable in the management of extensive bony defects of the limbs, but in approximately half the cases further surgery or complication can be anticipated.