Clinical applications of vascularized bone autografts.

Our experience with microvascular transfer of fibular grafts and composite osteocutaneous iliac flaps has shown that massive autogenous bone grafting with an intact vascular pedicle decreases the time to bony union and the duration of immobilization required for functional reconstruction of an extremity. The technique has proven reliable (87 per cent success rate) in the reconstruction of bone defects of greater than 6 to 8 cm following tumor resection or defects existing in a fibrotic, avascular bed. More importantly, these techniques have been applied for limb salvage in patients with tumors or with severely traumatized extremities that were not candidates for more traditional methods of bone grafting. In many cases, amputation would have been the only alternative.