The advantage of free transplantation of the blood-supplied iliac crest into the position of a bone defect over non-vascularizable plastic surgery

Introduction. Autotransplantation is necessary to replace large bone defects. Traditional reconstruction methods, such as autotransplantation of unvascularized bone, have limitations in the form of slow consolidation and a high risk of graft lysis. Free transplantation of the vascularized iliac crest bone graft (VICBG) is an advanced microsurgical technique that provides rapid graft engraftment and the ability to take soft tissues over a bone composite by preserving blood supply.

Objective: to compare the results of free non-vascular autoplasty and vascular pedicle autoplasty using the example of two clinical cases. Materials and methods. The article presents clinical cases of the use of free nonvascularized plastic surgery and VICBG. In the first case, the use of a non-vascularized graft was used to replace the resected segment of the right radius. In the second case, autotransplantation on the vascular pedicle was performed to replace a bone defect that occurred after a gunshot wound received in the conditions of the SVR.

Results. In the first clinical case, it was not possible to achieve complete consolidation of the fracture of the radius. The main reason was lysis of the transplanted iliac bone fragments. In the second clinical case, the graft took root completely, and there were no infections. Upon control after 3 months, the X-ray picture of bone consolidation at all levels showed no signs of osteolysis.

Discussion. The advantage of non-vascular autosteoplasty is the significantly shorter duration of surgery and the lack of proficiency in vascular suture techniques. The main disadvantage of the method is the high percentage of osteolysis and, as a result, the lack of bone consolidation. VICBG demonstrates advantages over non-vascular grafts: rapid consolidation (average time 3 months), low risk of osteolysis due to the preservation of blood supply inside the graft. Advantages: abundant bone supply, adaptive shape. Limitations: short vascular pedicle (6-8 cm), donor morbidity. Disadvantages: the long duration of the operation, the need for a surgeon with vascular suture skills to participate in the operation.

Conclusion. Free transplantation of the vascularized iliac crest is an effective method for complex bone defects after injury with the development of bone deficiency.

1. Karimzade G. D. Autotransplantation in the surgical treatment of severe upper limb injuries. Eurasian Scientific and medical journal "Sino", 2021, no 3, pp. 24–29. (In Russ.) https://doi.org/10.54538/27075265_2021_2_3_24

2. Amantur Zh., Yoshiev A.M., Zhanybai M. Effectiveness of an unvascularized autograft from the iliac crest in eliminating primary and secondary defects of the mandible. International Journal of Humanities and Natural Sciences, (107), 2025, vol. 8, pp. 204–214. (In Russ.)

3. Khodzhanov I.Yu., Rakhimov A.M., Kosimov A.A. Comparative analysis of the results of surgical treatment of non-fused fractures and false joints of the forearm bones. The genius of orthopedics, 2021, no 2, pp. 199–208. (In Russ.) https://doi.org/10.18019/1028-4427-2021-27-2-199-208

4. Khorak K.I., Kogan P.G., Parfeev D.G., Avdeev A.I., Morozov A.M., Piskareva M.E. The use of bone autoplasty in false joints of the humeral diaphysis. Bulletin of the medical institute "REAVIZ". Rehabilitation, Doctor and Health, 2024, no 14(1), pp. 68–76. https://doi.org/10.20340/vmi-rvz.2024.1.CLIN.5

5. Jaloux C., Bettex Q., Levadoux M. et al. Free vascularized medial femoral condyle corticoperiosteal flap with non-vascularized iliac crest graft for the treatment of recalcitrant clavicle non-union. J. Plast. Reconstr. Aesthet. Surg., 2020, no 73(7), pp. 1232–1238. https://doi.org/10.1016/j.bjps.2020.03.018

6. Tereshchuk S.V., Sukharev V.A., Kerimov A.A., Vasiliev E.A., Gritsyuk A.A., Khominets I.V. Method of eliminating a total gunshot defect of the calcaneus with a V-shaped graft from the iliac crest: a clinical case. Plastic surgery and aesthetic medicine, 2023, no (1), pp. 39–47.

7. Tsybul E.S., Rodomanova L.A. Possibilities and results of using reconstructive microsurgery technologies in the treatment of patients with deformities and defects of the calcaneus. Modern problems of science and education, 2022, no 1. (In Russ.) https://doi.org/10.17513/spno.31455

8. Xiao YB, Du W, Wu PF, Qing LM, Yu F, Tang JY. Pedicled iliac bone flap grafting in the treatment of late presentation Legg-Calvé-Perthes disease. Front Surg., 2023, no 29, 10, hh. 926109. https://doi.org/10.3389/fsurg.2023.926109

9. Golubev I.O., Sarukhanyan A.R., Merkulov M.V. and others. The effectiveness of blood-supplied and conventional bone grafting in achieving fusion with false humeral joints. The genius of orthopedics, 2021, no 2, pp. 182–186. (In Russ.)

10. Monastyrev V. V., Ponomarenko N.S., Tishkov N.V. The use of an autograft from the fibular diaphysis in the surgical treatment of patients with fractures of the proximal humerus on the background of critical osteoporosis. Acta Biomedica Scientifica (East Siberian Biomedical Journal), 2020, no 6, pp. 205–210. (In Russ.)

11. Davirov Sh.M., Urinboev P.U. Treatment of a patient with an open fracture of the humerus with extensive bone defect using bone grafting (a case from practice). The genius of orthopedics, 2022. no 1, pp. 91–96. (In Russ.)