Reconstruction of ulnar defect with vascularized rib graft: A case report

This case report describes the reconstruction of a segmental ulnar defect using a vascularized rib graft. A 27-year-old man was injured during military service by an improvised explosive device, resulting in bilateral through-the-knee amputations, left hand deformity, and a segmental left ulnar defect. After unsuccessful ulnar reconstruction with nonvascularized autologous bone and allograft bone substitutes, he presented to our institution. We removed the residual allograft fragments from the ulnar defect, harvested a vascularized left sixth rib with the intercostal artery and vein, secured the construct with internal hardware, and performed microanastomoses of the intercostal artery and vein to the posterior interosseous artery and vein. Postoperatively, he had a hematoma at the vascularized graft recipient site caused by anticoagulation therapy for his chronic deep vein thrombosis. Despite this, the rib graft successfully incorporated on the basis of radiographic and clinical examinations at 27 months. He had no pain and good function of the arm. The results of this case suggest that a vascularized rib graft for forearm reconstruction may be a viable option with minimal donor site morbidity. © 2015 Wiley Periodicals, Inc. Microsurgery 37:160-164, 2017.