Transfer of Vascularized Grafts of Iliac Bone to the Extremities

---

Salibian-Arthur-H. Anzel-Sanford-H. Salyer-William-A. The Journal of Bone and Joint Surgery (American Volume). 1987 Dec. 69-A(9). pp 1319-1327. ABSTRACT: We treated sixteen patients, all of whom had a large segmental defect of bone in an extremity, with transfer of a vascularized graft of the iliac crest. Thirteen patients had an open defect that required an osteomuscular or osteocutaneous graft; the other three had a closed segmental osseous defect and the graft of the iliac crest was transferred without soft tissue. The average length of the osseous defect was seven centimeters. For the defects of the lower extremity, the average time to osseous union was 8.8 months. For the defects of the upper extremity, it was four months. Three patients had delayed union due to difficulty in positioning the graft on the tibia and maintaining circulation to the overlying skin; this led us to modify our method of transfer. In six patients, we used an osteomuscular graft and a separate skin graft instead of the osteocutaneous flap. When performing the transfers to the tibia, we tried to place the graft in the coronal plane against the fibula for better alignment and stability. For the transfers to the distal part of the forearm, we did a double microvascular anastomosis. A severe injury to an extremity, in which a substantial segment of bone is lost along with a considerable amount of skin and soft tissue, may be considered so serious as to require amputation, but when the vascular and neural structures are either intact or reparable, salvage of the limb may be possible with a large vascularized bone graft. The salvage may be performed soon after the injury or as a reconstruction at a later date. Recent developments in microvascular surgery have engendered several regimens for transferring vascularized bone grafts, each of which has advantages and disadvantages.