Session VI - Reconstruction

Reconstruction of Post-Traumatic Long Bone Defect with Vascularized Bone Graft

Yuan-Kun Tu, MD; Steve Wen-Neng Ueng, MD; Wen-Lin Yeh, MD; Cheng-Yo Yen, MD; Kun-Chang Wang, MD, Chang Gung Memorial Hospital, Keelung, Taiwan

Purpose: Post-traumatic long bone defects longer than 6-8 cm usually need to be reconstructed with vascularized bone graft for better mechanical support and earlier bone healing. The purpose of this prospective study was to investigate our clinical results on 50 cases with vascularized bone graft reconstruction for bone defects in 5 years follow up.

Materials and Methods: Fifty patients, including 42 males and 8 females were enrolled in our study from 1990 to 1993. The locations of bone defects were over femur (10), tibia (32), humerus (2), forearm (4), and spine (2). The causes of bone loss included acute trauma (18), osteomyelitis (22), and infected or aseptic nonunion (10). We had performed 43 free fibula transfers, 4 free iliac transfers, and 3 free ribs transfers for our patients' reconstruction. The average length of bone defect was 10.2 cm (range from 6.5 to 19cm).

Results: The successful rate of free bone transfer surgery was 94%, with 3 cases who needed re-open surgery due to venous thrombosis. Infection rate was 10%, and nonunion rate over the vascularized graft's docking site was 6%. The average time needed for bone union was 4.2 months. Bone transfer over the lower extremity had significant more hypertrophy (72.5%) than that over the upper extremity (34.6%) (p<0.05). Fractures of vascularized bone grafts were noted in 4 patients who all subsequently obtained adequate bony fixation by plating. The functional outcomes were good in 88% of our cases.

Conclusions: Based on our study, vascularized bone transfers for the reconstruction of long bone defects were found to have satisfactory results. Hypertrophy of the grafted bone could be noted more over lower extremity reconstruction than in upper limbs.