extended bone loss has occurred, either primarily during trauma, or secondarily

after pathological tissue excision. We present our experience in the management

of large skeletal defects of the upper extremity with the free vascularized

fibular graft (FVFG).

Method: Eleven patients of age 7 to 43 years (mean 27 years) were treated with FVFG for upper extremity defects ranging from 6 to 18 cm (mean 10 cm) and have been followed-up from 1 to 10 years (mean 4 years). Nine defects involved the forearm and 2 involved the humerus. The etiology of the defects was infected nonunion in 4 cases, tumor in 4, osteomyelitis in one, aseptic nonunion in one

and congenital pseudarthrosis in one case. The microvascular flap was osseous in 10 and composite in one patient, with transfer of the soleus muscle. Plate and screw fixation was used in all cases.

Results: Graft healing was evident in 20 of 22 junction sites (91%) at an average time of 3 months (range 2,5 to 4 months). No perioperative complications and no stress fractures occurred. Donor site morbidity was negligible. Functional outcome has been good or excellent in 10 of 11 patients (91%) and no amputation was necessary.

Discussion and Conclusion: Microsurgical reconstruction of the upper extremity with the FVFG constitutes a viable treatment option. The FVFG allows for radical excision of pathological tissue and improves the biology at the recipient site.The shape and size of the FVFG matches that of the forearm bones and the humerus. Therefore, no hypertrophy is necessary and early resumption of function is possible upon graft incorporation, regardless of the defect dimensions. In our opinion, the FVFG is treatment of choice for large skeletal defects of the upper extremity.