What are Vascularized Bone Grafts?
In nonunions, the case in which a broken bone fails to heal in an acceptable period of time, alternative treatments to immobilization alone are considered. Occasionally, when this happens, new blood supply may need to be brought in to aid the healing process. Vascularized bone grafts include using bone donor sites near to or remote from the area for repair.
Scaphoid fractures are the most notable example in the wrist, especially those of the proximal pole, the part nearest the forearm. Avascular necrosis of the lunate, Kienböck’s Disease, often require a surgical procedure, such as a vascularized bone graft, in order to heal.
Traumatic bone loss and tubular bones of the upper extremity, from the metacarpals to the humerus, may be also considered for this form of surgical reconstruction.
There are two methods involving vascularized bone grafts:
Free Vascularized Bone Grafts
Bone grafting is possible because bone tissue has the ability to regenerate completely if properly transplanted. Free vascularized bone grafts are characterized by the removal of bone from the original donor blood supply, transplanting it to the affected area.
Pedicled Vascularized Bone Grafts
Pedicled vascularized bone grafts are characterized by maintaining the vascular blood supply of the donor bone graft, which then supports the bone to the affected region. The donor bone must be-be in proximity to the accepting bone graft site.
Success Rates of Vascularized Bone Grafts
Vascular bone grafts carry an increased risk of donor-site morbidity. Vascularized bone grafts promote bone healing and revascularize bone. They will thus accelerate fracture healing. Additionally, osteocytes are generally preserved, resulting in accelerated graft consolidation.
Vascular bone grafts typically offer superior biological and mechanical properties over nonvascular bone grafts. With this method, postimplant remodeling is minimized, preserving bone mass.
Vascularized Bone Graft as a Treatment Option
In treatments requiring management of bony defects, autologous bone grafts can be used as the mechanical structure for reconstruction to restore aesthetics and function. Deciding whether to vascularize a graft in long-bone or large-joint reconstruction requires lengthy consideration of the benefits and the risks.
The advantages of the vascularized bone graft over the nonvascularized bone graft relate to the provision of nutrients to the deep structures of the graft. Vascularized bone grafts are used to minimize graft resorption and subsequent mechanical failure with respects to preventing infection.
Historically, free vascularized bone graft applications for the upper extremity have included reconstructions after tumor resection, significant infections, or trauma. Although not common, the free vascularized bone graft has been reported in the treatment of conditions such as scaphoid and avascular necrosis of the scaphoid and lunate bones.
Additionally, vascularized bone grafts have been used for the treatment of Preiser’s disease and Kienböck’s disease.
If You Have Experienced a Bone Injury, Contact HandSport Surgery Institute
Please contact us as soon as possible to schedule an appointment with our talented team. People experiencing bone injuries should be evaluated to try and prevent further injury and mobility issues.
If you have been injured, it’s important to be evaluated by a highly skilled professional. Call Drs. Mark and Jason Pruzansky at 212-249-8700 to schedule an appointment, obtain an accurate diagnosis, and start to help you feel better.