{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T03:01:20Z","timestamp":1777086080754,"version":"3.51.4"},"reference-count":40,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Reconstr Microsurg"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Background\u2003Reconstruction of upper extremity osseous diaphyseal defects often requires complex reconstructions. In this study, we characterized and summarized the available literature on free vascularized bone flap (VBF) reconstruction for upper extremity diaphyseal defects.<\/jats:p><jats:p>\n          Methods\u2003A scoping review using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews was conducted. A literature search of major electronic databases was conducted to identify journal articles relating to the management of VBF reconstruction of upper limb long bone defects. Articles with patient-level data were included. Descriptive statistics were performed using Python.<\/jats:p><jats:p>\n          Results\u2003Overall, 364 patients were included in this study. The most common indications for VBFs included atrophic nonunion (125, 34.3%), postoncologic resection (125, 34.3%), septic nonunion (56, 15.4%), and trauma (36, 9.9%). Mean defect size was 8.53\u2009\u00b1\u20095.14\u2009cm. A total of 67 (18.4%) cases had defects\u2009&lt;\u20096\u2009cm, and 166 cases (45.6%) had defects\u2009&gt;\u20096\u2009cm. The fibula was the most utilized VBF (272, 74.73%), followed by the medial femoral condyle flap (69, 18.96%). Overall, primary union rate was 87.1%. Subsequent flap fracture rate was 3.3%. There were only two (0.6%) VBF losses reported in the included cases, and donor-site complications were similarly rare (17, 4.7%).<\/jats:p><jats:p>\n          Conclusion\u2003VBF reconstruction is often utilized for postoncologic defects and recalcitrant nonunions. The fibula is the most utilized VBF, but the medial femoral condyle flap is used frequently for smaller defects. VBF reconstruction demonstrates high union rates and low flap fracture rate across indications.<\/jats:p>","DOI":"10.1055\/a-2332-0150","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T23:02:17Z","timestamp":1716505337000},"page":"068-076","source":"Crossref","is-referenced-by-count":2,"title":["Upper Extremity Diaphyseal Osseous Gap Reconstruction with Free Vascularized Bone Flaps: A Scoping Review"],"prefix":"10.1055","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3312-0127","authenticated-orcid":false,"given":"Hani I.","family":"Naga","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina"},{"name":"Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2606-6027","authenticated-orcid":false,"given":"Joshua","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina"},{"name":"Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristina","family":"Dunworth","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina"},{"name":"Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Oleck","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina"},{"name":"Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Emovon","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina"},{"name":"Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Graton","sequence":"additional","affiliation":[{"name":"Department of Medical Library, Duke University Hospital, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suhail K.","family":"Mithani","sequence":"additional","affiliation":[{"name":"Division of Hand Surgery, Department of Surgery, Duke University, Durham, North Carolina"},{"name":"Division of Plastic Surgery, Department of Surgery, Duke University, Durham, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,6,21]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"28","DOI":"10.5435\/00124635-200401000-00005","article-title":"Management of posttraumatic segmental bone defects","volume":"12","author":"T A DeCoster","year":"2004","journal-title":"J Am Acad Orthop Surg"},{"issue":"S 04","key":"ref2","doi-asserted-by":"crossref","first-page":"S1","DOI":"10.1097\/BOT.0000000000002124","article-title":"Segmental bone defects and the history of bone transport","volume":"35","author":"M T Dahl","year":"2021","journal-title":"J Orthop Trauma"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"166","DOI":"10.2106\/00004623-198163010-00025","article-title":"Current concepts review: vascularized free bone transplants","volume":"63","author":"A J Weiland","year":"1981","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref4","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1111\/os.12213","article-title":"Acute limb shortening for major near and complete upper extremity amputations with associated neurovascular injury: a review of the literature","volume":"7","author":"N Kusnezov","year":"2015","journal-title":"Orthop Surg"},{"issue":"08","key":"ref5","doi-asserted-by":"crossref","first-page":"755","DOI":"10.1016\/j.jhsa.2018.03.055","article-title":"Bone graft options in upper-extremity surgery","volume":"43","author":"C S Klifto","year":"2018","journal-title":"J Hand Surg Am"},{"issue":"02","key":"ref6","doi-asserted-by":"crossref","first-page":"204","DOI":"10.2106\/00004623-199602000-00006","article-title":"Donor-site morbidity with use of vascularized autogenous fibular grafts","volume":"78","author":"T P Vail","year":"1996","journal-title":"J Bone Joint Surg Am"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"407","DOI":"10.3928\/0147-7447-19940501-05","article-title":"Vascularized bone grafts","volume":"17","author":"M A Pirela-Cruz","year":"2013","journal-title":"Orthopedics"},{"issue":"04","key":"ref8","doi-asserted-by":"crossref","first-page":"628e","DOI":"10.1097\/PRS.0000000000000513","article-title":"Functional outcomes of virtually planned free fibula flap reconstruction of the mandible","volume":"134","author":"T Avraham","year":"2014","journal-title":"Plast Reconstr Surg"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1097\/BSD.0b013e3181e666d0","article-title":"The results of vascularized-free fibular grafts in complex spinal reconstruction","volume":"24","author":"D B Ackerman","year":"2011","journal-title":"J Spinal Disord Tech"},{"issue":"04","key":"ref10","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.hcl.2012.08.005","article-title":"Free vascularized medial femoral condyle autograft for challenging upper extremity nonunions","volume":"28","author":"D B Jones Jr","year":"2012","journal-title":"Hand Clin"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1097\/01.prs.0000252306.72483.9b","article-title":"Reconstruction of extremity long bone defects after sarcoma resection with vascularized fibula flaps: a 10-year review","volume":"119","author":"C M Chen","year":"2007","journal-title":"Plast Reconstr Surg"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/j.jcms.2019.01.037","article-title":"The use of vascularized fibula flap in mandibular reconstruction; a comprehensive systematic review and meta-analysis of the observational studies","volume":"47","author":"M E Awad","year":"2019","journal-title":"J Craniomaxillofac Surg"},{"issue":"03","key":"ref13","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1002\/micr.20703","article-title":"The current role of the vascularized-fibular osteocutaneous graft in the treatment of segmental defects of the upper extremity","volume":"31","author":"S T Hollenbeck","year":"2011","journal-title":"Microsurgery"},{"issue":"05","key":"ref14","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1007\/s00590-021-02887-4","article-title":"Management of segmental bone defects of the upper limb: a scoping review with data synthesis to inform decision making","volume":"31","author":"N Ferreira","year":"2021","journal-title":"Eur J Orthop Surg Traumatol"},{"issue":"07","key":"ref15","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation","volume":"169","author":"A C Tricco","year":"2018","journal-title":"Ann Intern Med"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.46658\/JBIMES-20-12","volume-title":"Chapter 11: Scoping reviews","author":"M DJ Peters","year":"2020"},{"issue":"7825","key":"ref17","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1038\/s41586-020-2649-2","article-title":"Array programming with NumPy","volume":"585","author":"C R Harris","year":"2020","journal-title":"Nature"},{"issue":"03","key":"ref18","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/s41592-019-0686-2","article-title":"SciPy 1.0: fundamental algorithms for scientific computing in Python","volume":"17","author":"P Virtanen","year":"2020","journal-title":"Nat Methods"},{"issue":"11","key":"ref19","doi-asserted-by":"crossref","first-page":"2440","DOI":"10.2106\/00004623-200411000-00013","article-title":"Ununited diaphyseal forearm fractures with segmental defects: plate fixation and autogenous cancellous bone-grafting","volume":"86","author":"D Ring","year":"2004","journal-title":"J Bone Joint Surg Am"},{"issue":"06","key":"ref20","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1177\/1753193416650171","article-title":"Management of recalcitrant osteomyelitis and segmental bone loss of the forearm with the Masquelet technique","volume":"42","author":"T D Luo","year":"2017","journal-title":"J Hand Surg Eur Vol"},{"issue":"06","key":"ref21","doi-asserted-by":"crossref","first-page":"304","DOI":"10.5312\/wjo.v11.i6.304","article-title":"Role of the Ilizarov non-free bone plasty in the management of long bone defects and nonunion: problems solved and unsolved","volume":"11","author":"D Y Borzunov","year":"2020","journal-title":"World J Orthop"},{"issue":"197","key":"ref22","first-page":"32","article-title":"Fate of vascularized and nonvascularized autografts","author":"J W Shaffer","year":"1985","journal-title":"Clin Orthop Relat Res"},{"issue":"07","key":"ref23","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/00007632-198907000-00014","article-title":"Temporal analysis of vascularized and nonvascularized rib grafts in canine spine surgery","volume":"14","author":"J W Shaffer","year":"1989","journal-title":"Spine"},{"issue":"01","key":"ref24","doi-asserted-by":"crossref","first-page":"105","DOI":"10.2106\/00004623-198567010-00013","article-title":"A roentgenographic, biomechanical, and histological evaluation of vascularized and non-vascularized segmental fibular canine autografts","volume":"67","author":"P C Dell","year":"1985","journal-title":"J Bone Joint Surg Am"},{"issue":"01","key":"ref25","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1002\/(SICI)1097-0347(199901)21:1<66::AID-HED9>3.0.CO;2-Z","article-title":"Vascularized bone flaps versus nonvascularized bone grafts for mandibular reconstruction: an outcome analysis of primary bony union and endosseous implant success","volume":"21","author":"R D Foster","year":"1999","journal-title":"Head Neck"},{"issue":"02","key":"ref26","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1177\/1558944717736397","article-title":"Bone grafting for scaphoid nonunions: is free vascularized bone grafting superior for scaphoid nonunion?","volume":"14","author":"W R Aibinder","year":"2019","journal-title":"Hand (N Y)"},{"issue":"05","key":"ref27","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1007\/s00264-009-0862-6","article-title":"Treatment of scaphoid nonunion with vascularised and nonvascularised dorsal bone grafting from the distal radius","volume":"34","author":"S Ribak","year":"2010","journal-title":"Int Orthop"},{"issue":"03","key":"ref28","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jse.2004.06.007","article-title":"Free vascularized corticoperiosteal bone graft for the treatment of persistent nonunion of the clavicle","volume":"14","author":"B Fuchs","year":"2005","journal-title":"J Shoulder Elbow Surg"},{"issue":"05","key":"ref29","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1016\/S0363-5023(84)80006-4","article-title":"Vascularized bone grafts in the treatment of infected forearm nonunions","volume":"9","author":"P C Dell","year":"1984","journal-title":"J Hand Surg Am"},{"issue":"435","key":"ref30","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/01.blo.0000157928.20381.46","article-title":"Recalcitrant nonunion of the distal humerus: treatment with free vascularized bone grafting","author":"P K Beredjiklian","year":"2005","journal-title":"Clin Orthop Relat Res"},{"issue":"05","key":"ref31","doi-asserted-by":"crossref","first-page":"360","DOI":"10.5435\/00124635-200409000-00010","article-title":"Free vascularized fibular grafts for reconstruction of skeletal defects","volume":"12","author":"K N Malizos","year":"2004","journal-title":"J Am Acad Orthop Surg"},{"issue":"12","key":"ref32","doi-asserted-by":"crossref","first-page":"3653","DOI":"10.1016\/j.injury.2021.04.005","article-title":"Outcomes of free vascularized fibular graft for post-traumatic osteonecrosis of the femoral head","volume":"52","author":"M J Richard","year":"2021","journal-title":"Injury"},{"issue":"06","key":"ref33","doi-asserted-by":"crossref","first-page":"987","DOI":"10.2106\/00004623-200306000-00001","article-title":"Free vascularized fibular grafting for the treatment of postcollapse osteonecrosis of the femoral head","volume":"85","author":"K R Berend","year":"2003","journal-title":"J Bone Joint Surg Am"},{"issue":"04","key":"ref34","doi-asserted-by":"crossref","first-page":"541e","DOI":"10.1097\/PRS.0b013e318262f115","article-title":"A prospective study of preoperative computed tomographic angiographic mapping of free fibula osteocutaneous flaps for head and neck reconstruction","volume":"130","author":"P B Garvey","year":"2012","journal-title":"Plast Reconstr Surg"},{"issue":"02","key":"ref35","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1055\/s-0042-1748783","article-title":"Multifactorial analysis of treatment of long-bone nonunion with vascularized and nonvascularized bone grafts","volume":"15","author":"M Guidi","year":"2022","journal-title":"J Hand Microsurg"},{"issue":"07","key":"ref36","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1055\/s-0034-1372484","article-title":"Osteochondral flaps from the distal femur: expanding applications, harvest sites, and indications","volume":"30","author":"J P Higgins","year":"2014","journal-title":"J Reconstr Microsurg"},{"issue":"03","key":"ref37","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1177\/24730114231191135","article-title":"Medial femoral condyle free flap for persistent osseous nonunion of the first metatarsophalangeal joint: a preliminary report of a new surgical indication for the medial femoral condyle free flap","volume":"8","author":"D Kaiser","year":"2023","journal-title":"Foot Ankle Orthop"},{"issue":"01","key":"ref38","doi-asserted-by":"crossref","first-page":"100016","DOI":"10.1055\/s-0043-1760767","article-title":"Vascularized reconstruction of recalcitrant clavicular nonunion with the medial femoral condyle free flap: a systematic review of the literature","volume":"16","author":"Y G Karunaratne","year":"2024","journal-title":"J Hand Microsurg"},{"issue":"02","key":"ref39","doi-asserted-by":"crossref","first-page":"e80","DOI":"10.1097\/BOT.0000000000002186","article-title":"Treatment of recalcitrant femoral shaft nonunion with medial femoral condyle pedicled autograft: technical trick","volume":"36","author":"G J DeKeyser","year":"2022","journal-title":"J Orthop Trauma"},{"issue":"07","key":"ref40","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1055\/a-2004-2364","article-title":"Correlation between risk factors and healing times in long bone nonunions treated with corticoperiosteal flap from the medial femoral condyle","volume":"39","author":"M Guzzini","year":"2023","journal-title":"J Reconstr Microsurg"}],"container-title":["Journal of Reconstructive Microsurgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2332-0150.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T23:40:18Z","timestamp":1735083618000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2332-0150"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,23]]},"references-count":40,"journal-issue":{"issue":"01","published-online":{"date-parts":[[2024,12,24]]},"published-print":{"date-parts":[[2025,1]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2332-0150","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0743-684X","1098-8947"],"issn-type":[{"value":"0743-684X","type":"print"},{"value":"1098-8947","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,5,23]]},"published":{"date-parts":[[2024,5,23]]}}}