Upper Extremity Diaphyseal Osseous Gap Reconstruction with Free Vascularized Bone Flaps: A Scoping Review

Hani I. Naga; Joshua Kim; Kristina Dunworth; Nicholas Oleck; Emmanuel Emovon; Margaret Graton; Suhail K. Mithani

doi:10.1055/a-2332-0150

Journal of Reconstructive Microsurgery, Table of Contents

J Reconstr Microsurg 2025; 41(01): 068-076
DOI: 10.1055/a-2332-0150

Original Article

Upper Extremity Diaphyseal Osseous Gap Reconstruction with Free Vascularized Bone Flaps: A Scoping Review

Hani I. Naga

¹Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina

²Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina

,

Joshua Kim

¹Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina

²Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina

,

Kristina Dunworth

¹Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina

²Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina

,

Nicholas Oleck

¹Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina

²Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina

,

Emmanuel Emovon

¹Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina

²Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina

,

Margaret Graton

³Department of Medical Library, Duke University Hospital, Durham, North Carolina

,

Suhail K. Mithani

¹Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina

²Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina

› Author Affiliations

Abstract

Background Reconstruction of upper extremity osseous diaphyseal defects often requires complex reconstructions. In this study, we characterized and summarized the available literature on free vascularized bone flap (VBF) reconstruction for upper extremity diaphyseal defects.

Methods A scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews was conducted. A literature search of major electronic databases was conducted to identify journal articles relating to the management of VBF reconstruction of upper limb long bone defects. Articles with patient-level data were included. Descriptive statistics were performed using Python.

Results Overall, 364 patients were included in this study. The most common indications for VBFs included atrophic nonunion (125, 34.3%), postoncologic resection (125, 34.3%), septic nonunion (56, 15.4%), and trauma (36, 9.9%). Mean defect size was 8.53 ± 5.14 cm. A total of 67 (18.4%) cases had defects < 6 cm, and 166 cases (45.6%) had defects > 6 cm. The fibula was the most utilized VBF (272, 74.73%), followed by the medial femoral condyle flap (69, 18.96%). Overall, primary union rate was 87.1%. Subsequent flap fracture rate was 3.3%. There were only two (0.6%) VBF losses reported in the included cases, and donor-site complications were similarly rare (17, 4.7%).

Conclusion VBF reconstruction is often utilized for postoncologic defects and recalcitrant nonunions. The fibula is the most utilized VBF, but the medial femoral condyle flap is used frequently for smaller defects. VBF reconstruction demonstrates high union rates and low flap fracture rate across indications.

Keywords

upper extremity - osseous defects - fibula - vascularized bone - microsurgery

Full Text

References

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Supplementary Material

Supplementary Material