Vascularized Bone Graft Reconstruction for Upper Extremity Defects: A Review

Abstract

Upper extremity reconstruction may pose clinical challenges for surgeons due to the often-critical, complex functional demands of the damaged and/or missing structures. The advent of vascularized bone grafts (VBGs) has aided in reconstruction of upper extremity (UE) defects due to their superior regenerative properties compared with nonvascularized bone grafts, ability to reconstruct large bony defects, and multiple donor site options. VBGs may be pedicled or free transfers and have the potential for composite tissue transfers when bone and soft tissue are needed. This article provides a comprehensive up-to-date review of VBGs, the commonly reported donor sites, and their indications for the treatment of specific UE defects.

Reconstruction With Flow-Through Chimeric Anterolateral Thigh Flap Combining Vascularized Fibular Bone Graft for Extensive Composite Tissue Defect of the Forearm

“…Its regenerative properties is reinforced by vascularization, which both macroscopically and microenvironmentally provides oxygenation and nutrition, compared with nonvascularized graft. For this patient, the fibula was an anatomical match to the forearm defect, and its use was practical for single-stage reconstruction 18–20 . The vascularization of the bone graft enhanced the survival of the flap and decreased the risk of graft failure with high union rate.…”

“…In consideration of defects more than 5 to 6 cm, deficiency of robust local blood supply or salvage plan for previous failure bone graft, vascularized bone grafts are deemed to be superior resolution for upper limb reconstruction. 18 Its regenerative properties is reinforced by vascularization, which both macroscopically and microenvironmentally provides oxygenation and nutrition, compared with nonvascularized graft. For this patient, the fibula was an anatomical match to the forearm defect, and its use was practical for single-stage reconstruction.…”

“…For this patient, the fibula was an anatomical match to the forearm defect, and its use was practical for single-stage reconstruction. [18][19][20] The vascularization of the bone graft enhanced the survival of the flap and decreased the risk of graft failure with high union rate. According to the present meta-analysis, the overall primary union rate in 151 cases reached up to 95% and the flap survival rate was 97%.…”

“…Our patient was an adequate candidate for single-stage reconstruction because his hemodynamic status was stable, no severe infection occurred, and the risk of flap failure was low. In consideration of defects more than 5 to 6 cm, deficiency of robust local blood supply or salvage plan for previous failure bone graft, vascularized bone grafts are deemed to be superior resolution for upper limb reconstruction 18 . Its regenerative properties is reinforced by vascularization, which both macroscopically and microenvironmentally provides oxygenation and nutrition, compared with nonvascularized graft.…”

Application of stem cells in regeneration medicine

“… 116 Inflammatory cytokines play important role in regulating bone tissue destruction and promoting bone tissue regeneration. 90 Bone healing after an injury is a complex biological and biomechanical process, 117 and final healing is highly dependent on the initial inflammatory phase, which is influenced by local and systemic responses to the injury stimulus. In addition, immune cells and mesenchymal stromal cells are involved in critical intercellular communication and crosstalk to regulate bone healing.…”