Vascularized bone grafts to the upper extremities

From 1979 to 1995 in our clinic, vascularized bone grafting was performed in 29 patients with large bone defects, established nonunion, congenital pseudoarthrosis, or avascular necrosis in the upper extremity. Four patients had traumatic bone defects, six had posttraumatic nonunions, two had congenital pseudoarthroses, five had amputations, nine had defects following tumor resection, and three had other lesions. Reconstructed sites were the humerus in 7 patients, the radius in 12, the ulna in 2, both radius and ulna in 1, and the metacarpal and phalangeal bones in 7. Donor bones were fibula in 19 cases, radius in 6, scapula in 2, and medial condyle of the femur in 2. Postoperative circulatory disturbances and venous thrombosis resulted in revision surgery in two patients. Thrombectomy and reanastomosis to other veins were performed, and these flaps took successfully. No patients required additional bone grafts. The mean period required to obtain radiographic bone union was 4 months (fibula, 4.5 months; scapula, 3.5 months; radius, 2.6 months; medial condyle of the femur, 4 months). Vascularized fibula graft is indicated in patients with large bone defects in the humerus, radius, and/or ulna. The scapula is easy to transfer to the proximal humerus on its pedicle. This donor is indicated in young women because operative scars can be hidden. The radius is usually harvested with skin, and its use is indicated in patients with bone loss in the hand including thumb amputations. Thin corticoperiosteal graft from the femur is indicated in patients with established nonunion of the humerus and radius without significant bony defects.