Vascularized Bone Grafting in Orthopedic Surgery, An Issue of Orthopedic Clinics

Although the results of fracture repair have markedly improved over the past century, a significant proportion of orthopedic surgery still involves the reconstruction of bony defects and the stimulation of bone healing through the application of different bone graft materials. With advancements in the production of exogenous bone morphogenic proteins, mesenchymal stem cell harvest, and osteoconductive scaffolds, the requirements for vascularized bone have been reduced but not supplanted. Vascularized bone graft still remains an ideal source of bone replacement and more recent technical advancements have allowed for the transfer of viable growth plates and the restoration of blood flood to areas injured by avascular necrosis. Within this issue many of the pioneers of free microvascular bone transport provide their own historical perspective and long-term results in the treatment of difficult bony problems. In addition, more recent applications of vascularized bone grafts for the treatment of problems within the wrist, spine, and long bones are reviewed. Finally, we come full circle and examine Meekren's xenografting procedure again and the recent developments within the frontier of vascularized xenograft and allograft bone transfer.