Biologic Reconstructive Techniques for Intercalary Bone Loss

Management of segmental bone loss has been a difficult challenge with standard techniques of bone grafting. In recent times, there have been many surgical advances in this field, primarily stemming from our ability to address segmental bone loss. The aim of this article was to provide an overview of biologic techniques to manage these segmental bony defects, including their indications and outcomes. We will focus on the options of distraction osteogenesis, induced membrane technique, and vascularized bone grafting. There are scenarios that may call on one specific surgical approach over another. Distraction osteogenesis is a reliable option for traumatic injuries with adequate soft-tissue coverage, whereas the induced membrane technique may be best served for infected cases. Vascularized bone may be the best option when facing patients who require radiation or chemotherapy in the oncologic setting or have concurrent soft-tissue deficits in the trauma setting. The techniques may also be combined to take advantage of their individual attributes. Ultimately, a team approach should be used to determine the best reconstructive option for large segmental bony defects.