Vascularized Bone Transplantation

Overview

The many bone grafting methods which surgeons have used over the years have utilized a graft that serves primarily as a matrix with relatively few surviving osseous cells. Ostrup and Fredrickson (1974) were the first to scientifically investigate the fate of bone cells in grafts when circulation to the grafted bone could be maintained. Later, others confirmed experimentally that, under such conditions, osteocytes will survive, obviating the slow process of creeping substitution whereby dead bone is replaced by living bone (Berggren et al. 1982). The applicability of this experimental work to clinical cases continues to be a subject of spirited investigation.

This chapter deals with situations where nonvascularized bone grafts are likely to fail because of slow or absent bone healing. When faced with such problems, vascularized bone grafting provides an attractive alternative. To a great extent, bone healing relies on the ingrowth of vascularity from the surrounding bed. A nonvascularized graft may fail when used in a poorly vascularized bone graft bed or in abnormal bone, which is why vascularized bone grafts are advocated for irradiated or infected areas and areas with extensive fibrosis. In these situations, better healing is likely with the use of bone that has an independent vascular supply.