Vascularized periosteal transplant. A review of a new therapeutic possibility

: The idea of using vascularized periosteal flaps in reconstructing bone defects is more than one hundred years old. Up to now, experimental and clinical results regarding their osteogenic capacity have been a subject of debate. Experimental and clinical studies over the last ten years were able to demonstrate osteogenic capability of such vascularized periosteal flaps, provided the periosteum is well vascularized. To insure intact microcirculation, vascularized periosteal flaps must be freed up by sharp dissection. Small pieces of bone may be removed with the periosteum, whereas the periosteum must remain uninjured. There are many known donor sites in man: the iliac crest, the distal femur, the distal humerus and the tenth rib. There are no reports concerning donor site morbidity. Besides its osteogenic capacity, the periosteal flaps have "shape giving" and "space limiting" functions. The given volume within a periosteal flap rolled into a tube is the basis for the "Concept of the Given Space": the space within the tube defines where bone formation will occur, there being no loss of bone into the surrounding soft tissue. Because of the vascularized periosteal flap's fragility and the good results of other reconstructive procedures for segmental bone defects, there are few indications for extremity reconstruction using periosteal flaps: pseudarthrosis in the upper extremity is one example. In the lower extremity, a combination of vascularized periosteum with conventional and mainly vascularized bone grafts offers interesting possibilities for reconstruction.