Reconstruction of ulnar defect with vascularized rib graft: A case report

Abstract

This case report describes the reconstruction of a segmental ulnar defect using a vascularized rib graft. A 27-year-old man was injured during military service by an improvised explosive device, resulting in bilateral through-the-knee amputations, left hand deformity, and a segmental left ulnar defect. After unsuccessful ulnar reconstruction with nonvascularized autologous bone and allograft bone substitutes, he presented to our institution. We removed the residual allograft fragments from the ulnar defect, harvested a vascularized left sixth rib with the intercostal artery and vein, secured the construct with internal hardware, and performed microanastomoses of the intercostal artery and vein to the posterior interosseous artery and vein. Postoperatively, he had a hematoma at the vascularized graft recipient site caused by anticoagulation therapy for his chronic deep vein thrombosis. Despite this, the rib graft successfully incorporated on the basis of radiographic and clinical examinations at 27 months. He had no pain and good function of the arm. The results of this case suggest that a vascularized rib graft for forearm reconstruction may be a viable option with minimal donor site morbidity. © 2015 Wiley Periodicals, Inc. Microsurgery 37:160-164, 2017.

Free vascularized iliac periosteal graft for bilateral forearm nonunion reconstruction in a child with bilateral transfemoral amputation

“…The option of employing a scapular vascularized bone graft (Teot et al, 1981) was disregarded, owing to the need to preserve the patient's upper limbs for mobility. Vascularized rib grafts (Spiker et al, 2017) also were disregarded as an option, because of their poor mechanical features. Thus, we finally proposed employing a vascularized iliac bone flap, though this initially was refused by the parents until we offered to combine a VIPF with a bone allograft to reconstruct the defect and provide stability (Bakri et al, 2008; Soldado et al, 2012).…”

Primary Reconstruction of Mandibular Defects after Resection of Aggressive Pediatric Mandibular Tumors by Split Rib Bundle Bone Graft. A Retrospective Study

“…Ribs have often been used as free non-vascularised grafts [4,7,10,11] and, in recent years also as pedicled and free revascularized flaps [18,[28][29][30][31][32][33][34][35][36] . Such grafts may be either osseous, cartilaginous, or a combination of the two as a costochondral graft (CCG).…”

Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review

“… 92 93 94 The soft tissue potential of the flap is maximized when raised as an osteomyocutaneous flap with either or both the serratus anterior and latissimus dorsi. Limited case reports and series have shown beneficial outcomes in reconstruction of the clavicle, 95 humerus (including in pediatrics), 96 97 forearm, 96 97 98 metacarpal, 95 96 and phalanx accounting for 38 cases. 99 Donor-site morbidity includes hemothorax, pneumothorax or pleural tears, stress fractures, paresthesia or chronic pain given the neurovascular bundle is invariably taken with the posterior intercostal, and rarely, winged scapula.…”