Femoral reconstruction by vascularized bone transfer

Thirty‐five patients with extensive femoral defects or recalcitrant nonunions were reconstructed by microvascular bone transfer with a follow‐up period exceeding 12 months. The cause of bone defect included trauma, debridement for osteomyelitis, or tumor resection, and the cause of nonunion included trauma or postirradiation osteonecrosis. Sixty‐nine percent of patients healed primarily, whereas 83% of patients ultimately progressed to union following secondary surgery. One patient who initially healed later required amputation for late graft fracture with nonunion; therefore, at final follow‐up, 80% of patients were fully healed. Vascularized bone transfer merits strong consideration for reconstruction of atypical and particularly difficult femoral nonunions.