Transplantation of Bone and Joints

Basic Principles

Historically, areas that can be used for harvesting of vascular pedicled bone transplants include the ribs, scapula, ilium, radius, femur and fibula; however, the easiest of these to use are the fibula and the scapula. If a long bone of 7–8 cm or greater is required, then the fibula can be combined with a latissimus dorsi musculocutaneous flap or scapular flap, and in cases where only a small amount of bone but a large amount of soft tissue is required, the scapula is selected.

The PIP joint of the second toe is used for reconstructing PIP joints of the finger.

There is also a method of transferring a pedicled IDIP joint to the PIP joint, but in most cases there is a requirement that the digital arteries on both sides are patent. When harvesting from the second toe, although it is possible to retain the toe when harvesting the pedicled PIP joint, in cases where a large amount of bone needs to be harvested, there can often be problems with the remaining toe after surgery, so it is better to remove the second toe, with the consent of the patient.

The difficulty level of each surgical procedure is shown subsequent to the procedure title (e.g., Level of Difficulty: 2). The levels range from 1 to 5, with level 1 indicating a preliminary level and level 5 indicating a very advanced level.