Femoral reconstruction by vascularized bone transfer.

Thirty-five patients with extensive femoral defects or recalcitrant nonunions were reconstructed by microvascular bone transfer with a follow-up period exceeding 12 months. The cause of bone defect included trauma, debridement for osteomyelitis, or tumor resection, and the cause of nonunion included trauma or postirradiation osteonecrosis. Sixty-nine percent of patients healed primarily, whereas 83% of patients ultimately progressed to union following secondary surgery. One patient who initially healed later required amputation for late graft fracture with nonunion; therefore, at final follow-up, 80% of patients were fully healed. Vascularized bone transfer merits strong consideration for reconstruction of atypical and particularly difficult femoral nonunions.