The Vascularized Iliac Crest Bone Graft: An Often Forgotten Long Bone Alternative—now Remembered a Half-Century Later

For long bone large segmental defects, and especially for the tibia, the vascularized fibula osseous flap has been proven around the world to be the ideal and reliable solution. Yet if congenital, traumatic, oncologic, anatomical anomalies or even aesthetic reasons preclude this choice, a second tier alternative that is also reliable need be considered. A unique 40+ year follow-up for an infected non-union of a right tibia fracture, initially slated for limb amputation, was instead salvaged using a vascularized iliac crest bone graft [VICBG]. An updated focus on this event, the evolution of the VICBG surgical anatomy, and a concise description of a pragmatic dissection approach for this flap harvest is intended. A composite free groin flap and vascularized iliac crest bone graft pedicled by the deep circumflex iliac vessels proved to be a reasonable solution for a concomitant large lower limb soft tissue deficiency and tibial segmental defect. Now for more than 40 years the patient has retained a functional limb with no restrictions in ambulatory prowess. Over the past half-century, numerous donor sites for vascularized bone grafts have been identified. Some are primarily cortical, some cancellous; some tubular, some convoluted; some minute, some gargantuan; some rarely used, some often. Depending on the circumstances, a vascularized iliac crest bone graft can be a potential alternative where here demonstrated extremely long term success can be expected. This alternative should not be overlooked as a potential solution for what otherwise can be a demanding dilemma.