Free Vascularized Fibular Graft

Microsurgery opened a completely new field in bone transplantation with the free vascularized bone transfer. Oestrup and Fredrickson (1974) stressed that successful transplantation of bone is dependent on both the endosteal blood supply, i.e., the nutrient blood supply, and the periosteal blood supply. Using microsurgical techniques both blood supplies can be reestablished by anastomosing the donor vessels, artery and vein, to the recipient vessels (Berggren et al. 1982). After restoration of the blood supply the bony segment should be as well vascularized as a living bone, and therefore incorporation of the bone graft should be similar to fracture healing. Non-vascularized bone grafts will undergo complete remodeling until the periosteal and endosteal blood supply is reestablished. However, it is questionable whether, for example in free iliac crest grafts, the endosteal blood supply remains as effective as it was in the original site, since the medulla is no longer supplied by the original nutrient artery and vein.