Dolph Houben

33 Vascularized Bone Grafts, a closer look at the free fibula flap 2 studies have lead to the clinical usefulness of bone autograft and allograft reconstructions. However, careful analyses of the results suggest that a variety of problems are associated with this type of reconstruction as mentioned in the previous paragraph. Transplantation of a bone segment immediately revascularized by vascular repair was thought to solve these problems. The insertion of a piece of living bone that will exactly fill the gap and will continue to live without absorption has been attempted in 1891 by Dr. Phellps. He conducted a bizarre experiment in which he transplanted a piece of living bone from a dog as an interposition graft in a defect of the tibia of a boy. After transplantation, the patient and the dog were attached for 15 days. The transplantation failed and was removed after five weeks [19] . The desirability of a living bone graft above a non-vascularized allograft has been emphasized by several early investigators who used pedicled autologous fibula grafts for tibial reconstruction [20-22] . Reconstruction of a long defect may be accomplished by a mode of healing similar to that of segmental fracture rather than the usual more lengthy process of graft incorporation [23] . Pedicled bone grafts as rib, clavicle, iliac crest, scapula, humerus, radius, greater and lesser trochanter, medial femoral condyle, pisiform, and second metacarpal have been developed [24-33] . Free vascularized bone autografts involve the isolation of a bone segment on the nutrient vascular pedicle and its transfer to a distant site by microvascular anastomosis [23, 34] . This allows for the survival of osteogenic cells [35-37] . The microsurgical transfer of living autogenous tissue awaited the development of techniques and instruments for microvascular anastomosis. Due to improved microsurgical techniques and instruments, the development of free vascularized bone flaps was rapid [38] . Although the first procedure was performed by Ueba and Fujikawa in 1974 [39] , microvascular free fibula transfer as a technique for salvage of lower limb skeletal defects was first reported in the literature in 1975 by Taylor et al. [40] . Since that time, the vascularized fibular bone graft remains the most common vascularized bone graft due to its, predictable vascular pedicle, mechanical strength, and potential for hypertrophy and growth [41] . The free microvascular fibula transfer has become an important tool in the armamentarium of the reconstructive surgeon dealing with the management of long bone defects and difficult non-unions.