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Massive bone defects represent a challenge in orthopedics. The structural and biological contribution of vascularized bone flaps has significantly improved their treatment. Similarly, free vascularized periosteal flaps (VPF) have been used to treat bone defects in children, with higher flexibility, adaptability to the recipient's bed and good osteogenic and osteoinductive capacity. However, these are complex techniques related to donor area morbidity. We have started anatomical and clinical studies on the application of pediculated VPF in recalcitrant massive defects to reduce this morbidity. This article summarizes the fundamental aspects of the surgical technique, the main anatomical findings from cadaveric dissections and the applicability of pediculated VPF to treat biologically unfavorable bone defects at the upper limb. The authors review the vascularized humeral periosteal flap (VHPF), the dorso-ulnar and volar-radial forearm periosteal flaps and the vascularized first metacarpal periosteal flap, all described in previous papers. As a novelty, the dorsal wrist and hand VPF (4-5 radial periosteal flap and dorsum of the second metacarpal bone periosteal flap) are presented. In addition, clinical cases with recent VPF applications in common upper limb conditions are described.

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology