Vascularized Bone Graft for Treating Nonunion of the Leg Bones

Abstract

 Introduction: We report our results of treating nonunion of the leg bones with vascularized bone grafts.
 Methods: Between November 2003 and July 2010, we placed 9 vascularized bone grafts (6 free flaps, 3 pedicled flaps) in 9 patients (7 men; mean age, 63 years; range, 23 to 92 years). The nonunion site was in the femur in 3 patients and the tibia in 6. Bone defects ranged from 0.5 to 10 cm long (mean, 4.4 cm). Grafts came from 6 fibula, 2 ilea and 1 medial femoral condyle. External fixators were used in 6 patients, intramedullary nails in 2, and a plate in 1.
 Results: All flaps survived and bone union was acquired in all patients. One patient had skin and soft tissue necrosis in the donor site for harvesting fibula, which was treated with a free latissimus dorsi myocutaneous flap. Another suffered postoperative recalcitrant pneumonia and died 5 months later.
 Conclusion: Vascularized bone grafts can treat nonunion in the leg bones, but can cause surgical stress and major complications. Optimal results depend on preoperatively evaluating the vascularization of both donor and recipient bones; choosing a simple procedure (a reliable flap or a pedicled graft) ; and assessing the patient's general health, risks associated with past illnesses, and possible complications.