Vascularized Bone Graft in Mangled Hand Reconstruction

Extensive bone defects, especially in conjunction with associated coverage involvement in mangled hands, pose notably challenges to hand and upper-extremity surgeons. Vascularized bone grafts often play a vital role in effective treatment now a days. It not only bypasses the drawbacks of conventional grafts but also allows for simultaneous one-stage reconstruction of its coverage as well as repairs other injured structures. Preoperative evaluation of mangled hand is crucial; the injury extent, including circulation, patient expectations, and clinical reality, should be all taken into consideration before finalizing the reconstruction plan. The fibula bone, along with other vascularized bone flaps such as iliac crest bone, medial femoral condyle, and some others, as well as corresponding spare parts, can provide effective solutions. Considerations such as surgeons' experience and expertise, donor site morbidity, postoperative care, and rehabilitation are essential for optimal outcomes. In this article, we would like to share our current practicing vascularized bone flaps in mangled hand reconstructions.