Massive bone defects of the upper limb: reconstruction by vascularized bone transfer
The use of free microvascular bone segment transfer has become an accepted and, in many instances, the preferred technique for reconstructing massive defects of bone. This is true in either the upper or the lower limb. The advantages of this technique are suggested to be more rapid bone union, more rapid bone hypertrophy and fewer instances of late stress fracture or osteolysis. In addition, some authors suggest that microvascular autografts may be used under adverse surgical conditions including a septic field or in an irradiated field. The disadvantages of this technique are that microvascular bone transfer is a technically demanding procedure and requires a donor site that may result in some degree of morbidity. This chapter will focus on the indications and technique of microvascular bone transfers in the upper limb, with illustrative case examples.