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The Irreplaceable Free Flap: Part I. Skeletal Reconstruction by Microvascular Free Bone Transfer

1983; Lippincott Williams & Wilkins; Volume: 10; Issue: 1 Linguagem: Inglês

10.1097/00000637-198301000-00006

1536-3708

Vincent R. Hentz, Robert M. Pearl,

Shoulder and Clavicle Injuries

The majority of the cellular elements of a cancellous or cortical autograft do not survive transfer. The vascularity of the recipient site is of paramount importance to the revascularization of those elements that do survive and, thus, to the success of such bone grafts. A conventional bone graft placed in a recipient site rendered suboptimal by irradiation or trauma frequently fails to achieve the therapeutic goal even if it survives. In contrast, the cellular elements in bone transferred by microvascular surgical methods remain viable. Provided the microvascular anastomosis remains patent following transfer, it will survive and succeed even when placed in a suboptimal milieu. If rigidly fixed to viable bone by modern techniques of osteosynthesis, it heals by rapid primary union, not by the “creeping substitution” that characterizes the incorporation of conventional bone graft. Donor site selection depends primarily on recipient site needs. For segmental defects in long bones, portions of the fibula can be transferred on either the anterior tibial or peroneal vascular supply. For most other defects, particularly about the face and mandible, portions of the ileum can be transferred on the deep circumflex iliac artery system. With two operating teams, the time of surgery begins to approach that for conventional grafts. With increasing skill, the free transfer of bone becomes truly “free. ”