Abstract
Massive bone defects represent a challenge in orthopedics. The structural and biological
contribution of vascularized bone flaps has significantly improved their treatment.
Similarly, free vascularized periosteal flaps (VPF) have been used to treat bone defects
in children, with higher flexibility, adaptability to the recipient's bed and good
osteogenic and osteoinductive capacity. However, these are complex techniques related
to donor area morbidity. We have started anatomical and clinical studies on the application
of pediculated VPF in recalcitrant massive defects to reduce this morbidity. This
article summarizes the fundamental aspects of the surgical technique, the main anatomical
findings from cadaveric dissections and the applicability of pediculated VPF to treat
biologically unfavorable bone defects at the upper limb. The authors review the vascularized
humeral periosteal flap (VHPF), the dorso-ulnar and volar-radial forearm periosteal
flaps and the vascularized first metacarpal periosteal flap, all described in previous
papers. As a novelty, the dorsal wrist and hand VPF (4-5 radial periosteal flap and
dorsum of the second metacarpal bone periosteal flap) are presented. In addition,
clinical cases with recent VPF applications in common upper limb conditions are described.
Keywords
vascularized periosteal flap - pediculated flap - periosteum - upper extremity - pseudoarthrosis
- bone defect
