Vascularized autografts for reconstruction of skeletal defects following lower extremity trauma. A review

Over the last 15 years, vascularized bone grafts have proved to be a valuable method of reconstructing skeletal defects in the extremities. Successful skeletal reconstruction has been reported following tumor resection, select traumatic skeletal defects, congenital pseudarthrosis, and both infected and uninfected skeletal nonunions unresponsive to conventional methodology. Incorporation of the graft into the recipient is not as dependent on an uninfected well-vascularized host as a conventional avascular autogenous graft is. Vascularized autografts are also capable of achieving union across large skeletal defects with fewer stress fractures than when avascular autografts are used to span a defect greater than 6 cm. With patency of the vascular anastomoses and union at both ends of the graft, hypertrophy of the segmental graft is not unusual. The overall success rate of ultimate bony union is approximately 80% and is mostly dependent on the recipient location. As discussed in this article, vascularized autografts are a salvage procedure to be used in reconstructing extremities in which conventional reconstructive techniques have failed or are not applicable.