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Schaeffer et al. Plast Aesthet Res 2022;9:27 Plastic and
DOI: 10.20517/2347-9264.2021.122
Aesthetic Research

Review Open Access

Tackling bone loss of the lower extremity:
vascularized bone grafting

Christine V. Schaeffer, John T. Stranix

Department of Plastic and Reconstructive Surgery, The University of Virginia, Charlottesville, VA 22903, USA.
Correspondence to: Dr. John T. Stranix. Department of Plastic and Reconstructive Surgery, The University of Virginia, PO Box
800376, Charlottesville, VA 22903, USA. E-mail: jts3v@virginia.edu

How to cite this article: Schaeffer CV, Stranix JT. Tackling bone loss of the lower extremity: vascularized bone grafting. Plast
Aesthet Res 2022;9:27. https://dx.doi.org/10.20517/2347-9264.2021.122

Received: 12 Nov 2021 First Decision: 29 Dec 2021 Revised: 31 Jan 2022 Accepted: 7 Mar 2022 Published: 9 Apr 2022

Academic Editor: Matthew L Iorio Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Post-traumatic lower extremity bone loss in the setting of high-energy trauma can occur acutely as a result of an
open fracture and surgical debridement, or secondarily as a result of nonunion or infection. Several techniques have
been described in the literature for the management of these bony defects, including non-vascularized bone grafts,
vascularized bone grafts and distraction osteogenesis. Herein, the authors review the role of vascularized bone
grafts in the management of post-traumatic bone loss in the lower extremity.

Keywords: Lower extremity, vascularized bone, segmental defect

INTRODUCTION
The first step in the management of patients with high energy trauma resulting in open fractures of the
lower extremity includes early and aggressive debridement of devitalized and contaminated soft tissue and
[1,2]
bone. Multiple operative debridements are often required before bony reconstruction can be considered .
Bone defects following lower extremity trauma occur acutely in the setting of significant fracture
comminution, open fractures, and following aggressive debridement and secondarily in the setting of
aseptic or septic nonunion. Temporary external fixators are used to stabilize the extremity and maintain
[3]
length . The goal of bony reconstruction is to provide stability and reestablish limb length.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
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