Microsurgery in bone loss and non-union of upper limb

Vascularized bone grafts (VBGs) are largely utilized to reconstruct upper limb bone defects. Many techniques are available for orthopedics and hand surgeons, but the decision-making is related to the dimension of the bone defect: smaller defects, up to 5-6 cm, without infection and with adequate vascular supply could be reconstructed by conventional bone grafting. For larger defects, more than 6 cm, or in consequence of recalcitrant non-union or after an infection, VBGs are considered the gold standard treatment as vascularized fibular graft (VFG) osteo-flap or osteo-cutaneous flap for composite defects. There is another emergent flap, the vascularized medial femoral condyle (VMFC) free flap mainly indicated for the reconstruction of small bone defect and scaphoid nonunion. The aim of this study is to underline indications, contraindications and complications of the use of VBGs in bone loss and non-union in upper limb.