Possibilities and results of (free) vascularized bone graft of the hand and wrist

The vascularized bone transplantation or graft is a modern and successful treatment concept in segmental bone loss. Faster healing and higher union rates were shown in several studies. Using vascularized bone grafts, the adaption in mechanical conditions as well as stability are improved. The indications, however, must be critically considered in order to obtain an optimal result. Reconstruction of the bone defect should be performed as quickly as possible after the trauma, infection, or tumor resection. Amputation should always remain the method of last choice. Depending on the existing bone defect, there are various possible donor sites, e.g., fibula, scapula, ulna, femur, and hip bone. The advantages and disadvantages of each donor site has to be thoroughly discussed prior to the operation to assure an optimal postoperative result. In view of these issues, vascularized bone grafts should be performed in microvascular specialized plastic or hand surgery centers. © 2011 Springer.