Free vascularized bone transplants in problematic nonunions of fractures.

Three cases with nonunion of long bones and problems of bone loss or infection, when conventional bone graft would probably not have been successful, were treated successfully by free vascularized bone transplant to provide a vascular bed in the nonunion site and internal splint, the donor bone being the composite rib graft based on posterior intercostal vessels and proximal fibula based on its peroneal vascular pedicle. The operative technique was divided into five stages, and each stage posed different problems at the donor and recipient areas and vessel anastomoses. Despite these disadvantages, all three cases proceeded to solid bony union in less than 4 months after surgery. Thus the patients were able to be rehabilitated early to retain satisfactory limb function within a relatively short period of time.