Vascularized Bone Flaps in Extremity Reconstruction: A Case Series

Purpose: Composite tissue defects encompassing bone and/or isolated bony defects can be challenging and critical for successful functional limb salvage. Vascularized bone flaps (VBFs) can provide a one-stage solution for autologous bony replacement in situations with large or complex bone defects and are often superior options compared with nonvascularized bone grafts or non-bone internal fixation techniques.

Methods: A retrospective review of VBFs performed by a single surgeon over a seven year period was conducted.

Results: Twenty-seven total VBFs were completed for traumatic, oncologic, and congenital cases. Patient age ranged from 5 to 64 years with the majority of patients being younger than 30 years old.  Anatomical bony reconstructions included 13 upper versus 11 lower extremity defects and 3 pelvic defects. Etiology of injuries included 16 traumatic, 6 oncologic (3 of which were pediatric cases), and 5 degenerative bony states. Successful union or bone healing was observed in 26 of 27 cases, with the following complications noted: 2 cases of delayed soft tissue wound healing and 1 case of complete resorption of a fibula bone flap requiring salvage with an expandable megaprosthetic and additional soft tissue flap coverage.

Conclusion: VBFs have critical roles in successful limb salvage outcomes where certain bony defects are encountered. As evidenced in our series, VBFs provide reliable single stage autologous bony reconstructions with relatively low and acceptable complication rates while achieving more functional outcomes. This series demonstrates the utility and success of VBFs for a variety of clinical situations.