Dolph Houben

49 Vascularized Bone Grafts, a closer look at the free fibula flap 2 Figure 7: porcine hind-limb model demonstrating a vascularized tibia segment transplanted into a recipient, while simultaneously implanting an autogenous arteriovenous bundle into the intramedullary space. The arteriovenous bundle induces autogenous revascularisationwithin the allotransplant andmaintains viabilitywith only short-term immunosuppression. Summary Vascularized bone transfers have been used since the 19 th century for the treatment of skeletal defects because of faster union rates, fewer fatigue fractures, rapid hypertrophy, and less resorption compared with non-vascularized bone transfer [49, 87] . Its structure and shape make it particularly useful for diaphyseal reconstruction; a straight segment of bone between 26 and 30 cm can be harvested, and stability can be obtained rigid internal fixation to the recipient's bone. For tumor indications, the use of microvascular reconstruction results does not result in an increased risk of local recurrence or death from metastatic disease. Primary union rates have been found in literature 67-84%. However, after secondary bone grafting the rate of union is 81- 92% [23, 72] . Complication rates after vascularized bone grafting for reconstruction of a bone defect in the lower extremity are strongly dependent on location, and underlying reason of the defect. Patients who were treated with a vascularized bone graft for treatment of a large bone defect due to osteomyelitis have the highest risk for complications. Vascularized autografts are limited by the few available expendable donor sites, and by donor site morbidity. However, vascularized bone grafts currently remain the golden standard for the reconstruction of large segmental bone defects while complications are manageable.