The bone flap and its blood supply are taken from the other lower limb and transplanted to fill the defect using microsurgery where blood vessels are connected to healthy blood vessels on the affected limb.

Bony reconstructions are required for the following conditions:

Segmental bone loss following trauma
Semental bone lose following cancer removal like in the jaw bone or mid face bone or forearm or leg bones
Short gap non-union
Long gap non-union
Osteomyelitis

Segmental losses of long bones following a fracture are caused by high-velocity injuries that fracture the bone in two places, crushing the segment in between or depriving the segment of blood flow.

This condition is also known as a critical segmental defect involving bone voids requiring intervention. The length of a critical bone defect is at least 4cms or greater than 2 cm.

Plastic surgeons prefer to use healthy vascularized bone flaps to restore the length of the limb bones and bring about union between the ends. They focus on uniting bone with vascularized tissues at both ends. .

Nonunions occur when a broken bone fails to heal after adequate surgical and nonsurgical treatment, especially during the initial three months and up to nine months after the injury.

The doctor will evaluate the patient's comorbidities must determine the extent of the bony union slack. Nonunions are complex conditions that require extensive evaluation.

Usually, nonunions occur in small bones of the hand, such as finger phalanges, and in long bones like the tibia and humerus. It is possible to get successful unions by using vascularized bone.

Unfortunately, osteomyelitis is a long-term condition that severely impacts function if not treated aggressively. In addition, it is a serious and difficult condition to treat. This condition is treated by removing all bacteria and dead bone fragments, releasing all surrounding scar tissue, reducing edema and inflammation, and providing antibiotic therapy.Again, for chronic osteomyelitis, several contributory issues can be found like:

Inadequate blood supply causing dead bone
Infection nidus which is usually the dead bone piece
Inadequate soft tissue cover
Surrounding scars

Chronic osteomyelitis patients will benefit with a vascularized bone flap surgery, which will bring in healthy bone with good blood supply to the bone and a healthy skin cover, so no bone is exposed.

Should You Have Limb Reconstruction Surgery?

Detailed investigation and accurate diagnosis along with existing health issues, injuries and infections are considered before proceeding with a limb reconstruction surgery. The focus of this surgery is to bring about union at fracture ends, while reducing pain and improving mobility.

As a practising Reconstructive and Hand surgeon in Mumbai, Dr Leena Jain has performed bony reconstruction procedures using vascularized bone in the following cases:

Reconstruction of mandibular defects
Salvage reconstruction of temporomandibular joint
Reconstruction of bones in the upper limb - humerus, radius, ulna, metacarpal, and phalangeal bones
Reconstruction of bones in the lower limb - femur, tibia, foot
Treatment for scaphoid non-union
Treatment of chronic osteomyelitis.

Limb reconstruction surgery is a serious procedure that has the potential to improve a patient's quality of life. However, it also has many risks and complications. Therefore, understand every aspect before proceeding with limb reconstruction surgery. Also, it is advisable to consult and clear all the doubts related to the surgery well in advance.

Expected Outcome of the bony limb reconstruction

Most limb reconstruction procedures are successful. The bone defects heal well, and there is significantly less chance of rejection of bone grafts.

However, choosing an expert and experienced plastic surgeon who has performed similar limb reconstructions is essential. Dr Leena Jain is a leading plastic surgeon in Bandra, and Borivali performs such surgeries with great skill and expertise.