PubMed · 16129190
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Judith E Woll, David M Smith. 2005. Bone and connective tissue.. https://doi.org/10.1016/j.cll.2005.06.003
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Most scaphoid non-unions can be treated successfully with conventional bone graft and screw fixation. Only a few cases with established avascular necrosis of the proximal fragment and previous failed conventional bone grafting should undergo vascularized bone graft. Cases in which the fragments are too small to accommodate a vascularized bone graft are better treated by alternative procedures. This article describes the role of vascularized bone grafting for scaphoid non-union, indications, donor bone selection, the authors' operative technique for vascularized bone graft from the supracondylar region of the femur, outcomes, and complications.
Vascularized bone grafting seems to be a valuable reconstructive technique for the treatment of osteomyelitis with skeletal defects greater than 6 cm in length. Fibular osteocutaneous, composite rib, and iliac osteocutaneous flaps are the most commonly used vascularized bone grafts clinically. Vascularized bone can obliterate dead space, bridge large bone defects, enhance bone healing, resist infection by ensuring blood supply, allow early rehabilitation, and ensure better clinical outcomes in the treatment of lower extremity osteomyelitis. Success rates range from 80% to 95%. Complications of surgery include anastomosis failure, donor site problems, and fracture of the grafted bone.
This article presents the history and development of as well as the results from the various techniques of vascularized bone grafting for the treatment of osteonecrosis (ON) of the femoral head. The authors have treated more than 2600 patients who had femoral head ON, using a vascularized fibular graft by way of an intraosseous approach. The results from this vast experience are summarized and certain pearls and pitfalls regarding the treatment of femoral head ON using the free vascularized fibular graft are highlighted.