vascularized bone flap is a reconstruction option that the Plastic Surgeons with the Bone Healing program are able to offer as part of the treatment for difficult bone healing problems. This involves taking bone with its vascular supply from one area of a patient’s body, and placing it in the affected area – “filling the hole” created because of a bone healing problem. The area is first prepared by the orthopedic surgeon, who removes all the non-living bone fragments and hardware (plates & screws) that might have been placed in the bone to hold it in place.

Vascularized bone flaps are a good option is because a live bone is placed in the area of a defect, the blood supply is re-attached so the bone continues to receive the nutrients it need to heal into the area. The size of the defect and presence of infection are limiting factors in the surgeons being able to use this as a treatment option.

Common bone flaps utilized by the Bone Healing team include:

Fibular flaps - the fibula is the smaller of the two bones in the lower leg.  The middle third of the fibula is used for vascularized bone flaps, leaving the sections of the fibula that make up the ankle and the area near the knee.

Drawing of the area of fibula used for a vascularized bone flap

Scapular flaps - the scapula is commonly called the shoulder blade. A small area along the lateral (outside) edge of the scapula is used for a vascularized bone flap.

Anatomy drawing of the scapula, the area used for a vascularized flap is shaded gray.

Iliac crest flaps - the iliac crest is the upper portion of the pelvic bone that can be felt along the back.  This is an area of bone commonly used in spine fusion surgeries as well.

The area in red is commonly used for a vascularized bone graft.