الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
Reconstruction of large bone defects has always posed a challenge for orthopaedic surgeons. With the development of the microvascular technique, (FVFG) has been introduced. Theoretically, preserving the arterial blood supply of the periosteum and endosteum enables primary healing as induced by vital osteoblasts.
Reconstruction of upper limb bone defects is a subject of major concern and debate. The advantages of the vascularized bone technique: reliable and fast healing, rapid hypertrophy, resistance to infection and ability to solve defects in the most unfavourable scenarios (scarred or irradiated beds) have been recognized and accepted by the reconstructive community. Vascularized bone grafts became rapidly popular, to the point that nearly every bone of the human body has been transplanted, and it is used on an everyday basis.
In orthopaedic practice, bone grafting is a common procedure used to enhance bone regeneration and restore skeletal integrity. Bone grafts can be classified into: vascularized and non vascularized bone grafts. In addition, bone grafts can be classified according to the source of origin into: auto grafts, allografts, xenografts and cancellous bone substitutes. According to structure of the grafts they can be classified into: cortical providing structural support and cancellous providing osteogenic potential. Probably all or most of the cellular elements in grafts (particularly cortical grafts) die and are slowly replaced by creeping substitution, thus the graft merely acts as a scaffold for the formation of new bone. This process of creeping substitution was described as penetration of newly formed bone directly into the old bone in a process that required the simultaneous removal of the necrotic trabeculae of the devascularized bone and subsequent deposition of new bone. In hard cortical bone this process of replacement is considerably slower than in spongy or cancellous bone.
Blood flow through cortical bone depends on an intact medullary blood supply, whereas periosteal arteries play a relatively minor role in cortical nutrition. The medullary blood supply receives major contributions from nutrient arteries, which penetrate the cortex through nutrient foramina and nutrient canals. The surrounding muscles provide the blood supply to the periosteum, but these play a relatively minor role in cortical blood supply. Fortunately, one predominant nutrient vessel supplies most long bones. If this primary vessel is preserved, a large segment of bone can be transplanted as a living graft. With the nutrient supply maintained, osteocytes and osteoblasts in the graft can survive and the graft can heal to recipient bone rapidly, in a manner independent of the recipient bed and without the need for creeping substitution.
Classically, the flow of blood through the cortex connecting the nutrient artery and the periosteal plexus of vessels was thought to be centripetal but more recent evidence suggests a centrifugal pattern of flow. Parallel to the way of skin perfusion, the periosteal vascular plexus can be classified into three different types: direct periosteal, musculoperiosteal and fascioperiosteal.
In a vascularized bone graft, microvascular anastomosis to the recipient vessels preserves circulation to the graft and allows osteoblasts and osteocytes to survive. Healing occurs in a manner similar to that of a segmental fracture, without the need for ”creeping substitution”. Healing is more rapid and the incidence of non-union is minimized. With its vascular supply intact, the graft can remodel in response to biomechanical stresses, and will hypertrophy when axially loaded. This increases the strength and stiffness of the transferred graft, shortens the post-operative immobilization period, and lowers the incidence of fatigue fractures.
The indications reconstruction are vario include reconstruction 0 less than 6 cm associat salvage procedures fol atrophic non-union wit arthrodesis and certain s scaphoid non-union, di hands and ulnar pseudo-
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This study inv who underwent upp osteoseptocutaneous underlying etiologies, of such procedures.
Vascularized reconstructing bone fibular epiphysis is transfer were done a distal radius with incorporated welL sh peculiar complica cardiomyopathy (cas
llary The indications of vascularized bone graft in upper extremity e m reconstruction are various and continuously expanding. Nowadays they IOns include reconstruction of major bony defects exceeding 6 cm, small defects
ma less than 6 cm associated with infected, scarred or irradiated beds, limb y to salvage procedures following tumour resection, some benign lesions, lood atrophic non-union with a gap, recalcitrant non-union, chronic infections, long arthrodesis and certain specific indications such as free epiphyseal transfer, n be scaphoid non-union, difficult non-union of the clavicle, congenital club . d hands and ulnar pseudo-arthrosis.
ne ,
al to The contraindications to vascularized bone grafts transfer may be
and subdivided into four major categories:
1. Factors related to the surgeon.
the 2. Factors related to the patient general condition.
o be 3. Factors related to the donor site.
ow. 4. Factors related to the recipient site.
n be This study involves analysis of 22 patients (average: 29.91 years)
1 and who underwent upper limb microvascular reconstruction using free osteoseptocutaneous fibula grafting regarding their demographic data, the underlying etiologies, the procedures they were involved in and the results
s and of such procedures.
of a Vascularized epiphyseal transfer is an attractive solution for ng IS reconstructing bone defects in skeletally immature patients. The proximal cular fibular epiphysis is an ideal donor site. Three cases of free epiphyseal sses, transfer were done and analyzed. All cases involved reconstruction of the
and distal radius with the proximal fibular epiphysis and these cases ation incorporated well, showed solid union and hypertrophy but exhibited certain peculiar complications which included, post-operative acute cardiomyopathy (case 10), complete skin paddle necrosis (case 11). Despite