New options for vascularized bone reconstruction in the upper extremity.

Area of Science:

• Orthopedic Surgery
• Regenerative Medicine
• Musculoskeletal Research

Background:

• Vascularized bone grafting, established since the 1970s, is crucial for bony defects and non-unions.
• While common in lower extremities, novel techniques are emerging for complex upper extremity conditions.

Purpose of the Study:

• To review diverse vascularized bone grafting techniques for upper extremity pathologies.
• To highlight current standards and emerging options for bone reconstruction in the arm and hand.

Main Methods:

• Review of established and novel vascularized bone grafting techniques.
• Analysis of graft suitability for different upper extremity bone defects and non-unions.

Main Results:

• The vascularized fibula is the gold standard for large humerus/forearm defects and carpal reconstruction.
• Other options include vascularized scapula grafts, Capanna technique, MFC free flap, and rib transfers.
• Specific techniques are viable for carpal non-unions and epiphyseal transfer offers growth potential in pediatric cases.

Conclusions:

• A range of vascularized bone grafts effectively address upper extremity bone defects and non-unions.
• Technique selection depends on defect size, location, and patient skeletal maturity.
• Vascularized bone grafting continues to advance reconstructive possibilities in the upper extremity.