We treated sixteen patients, all of whom had a large segmental defect of
bone in an extremity, with transfer of a vascularized graft of the iliac
crest. Thirteen patients had an open defect that required an osteomuscular
or osteocutaneous graft; the other three had a closed segmental osseous
defect and the graft of the iliac crest was transferred without soft
tissue. The average length of the osseous defect was seven centimeters. For
the defects of the lower extremity, the average time to osseous union was
8.8 months. For the defects of the upper extremity, it was four months.
Three patients had delayed union due to difficulty in positioning the graft
on the tibia and maintaining circulation to the overlying skin; this led us
to modify our method of transfer. In six patients, we used an osteomuscular
graft and a separate skin graft instead of the osteocutaneous flap. When
performing the transfers to the tibia, we tried to place the graft in the
coronal plane against the fibula for better alignment and stability. For
the transfers to the distal part of the forearm, we did a double
microvascular anastomosis.