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Vascularized bone grafts to the upper extremities

H Yajima1, S Tamai, H Ono

  • 1Department of Orthopaedic Surgery at the Nara Medical University, Kashihara, Japan.

Plastic and Reconstructive Surgery
|March 21, 1998
PubMed
Summary

Vascularized bone grafting effectively reconstructs large upper extremity bone defects, achieving union in a mean of 4 months. Specific donor sites like the fibula, scapula, and radius offer tailored solutions for various bone loss scenarios.

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Area of Science:

  • Orthopedic Surgery
  • Microsurgery
  • Reconstructive Surgery

Background:

  • Vascularized bone grafting is a reconstructive technique for significant bone defects.
  • Indications include nonunion, congenital pseudoarthrosis, avascular necrosis, and post-traumatic defects.
  • The upper extremity presents unique challenges for bone reconstruction.

Observation:

  • A retrospective review of 29 patients undergoing vascularized bone grafting in the upper extremity from 1979-1995.
  • Reconstruction sites included humerus, radius, ulna, and hand bones.
  • Donor sites utilized were fibula, radius, scapula, and medial femoral condyle.

Findings:

  • Successful union was achieved in all cases without additional bone grafts.
  • Mean radiographic union time was 4 months, with variations by donor site (fibula 4.5, scapula 3.5, radius 2.6 months).

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  • Vascularized fibula grafts are suitable for humerus/radius/ulna defects; scapula for proximal humerus in women; radius for hand/thumb defects; and femur grafts for humerus/radius nonunion.

    • Implications:

    • Vascularized bone grafting is a reliable method for complex upper extremity bone defects.
    • Donor site selection should be tailored to the specific defect and patient.
    • Further research can optimize graft choices and surgical techniques for improved outcomes.