Bone reconstruction.

The reconstruction of bone defects relies upon the reconstitution of bone in the area. The basic concepts of fracture healing are presented to better understand the mechanism of bone grafting. Conventional bone graft techniques are quite effective in reconstructing defects, including those up to 25 cm in length, provided an adequate vascular bed is available to allow vascularization of the grafts. If an adequate milieu is not available, then the use of a pedicle or free vascular bone graft can be employed. Just as skin and muscle flaps have provided the solution to soft-tissue loss, vascularized bone grafts provide the technique to deal with large bone defects not amenable to conventional treatment. Allografts additionally have a place in skeletal reconstruction but require appropriate management and consideration of host immune response.