Vascularized bone grafts in spinal reconstruction: An updated comprehensive review

ABSTRACT In the past two decades, plastic surgeons have advanced to the forefront of spinal surgery, joining orthopedic and neurosurgeons in the multidisciplinary field of spino-plastics. As the global disease burden grows with an increased incidence of spinal pathologies, vascularized bone grafts (VBGs) define the current frontier of spino-plastic surgery. Vascularized bone grafting involves lifting segments of bone with the muscular attachments but without the inclusion of a named vessel. When compared to traditional nonvascular bone grafts and allografts, VBGs have come forward as a favored technique for complex spinal reconstruction due to the unique opportunity to capitalize on the relationship between the tendons and Sharpey's fibers which maintain blood flow to both the bone and muscular segments. This technique ensures robust autologous tissue rearrangement and also takes advantage of the osteoinductive properties of the bone segments, promoting adequate structural support and the perfusion necessary for efficient direct healing and fusion in intricate spine reconstructions. Another one of the many favorable qualities of VBGs is the diversity of sources available to surgeons. The review explores the role of VBGs in enhancing spinal fusion rates and minimizing morbidity compared to traditional approaches. Additionally, a detailed examination of six common VBG sources-the iliac crest, ribs, medial scapula, occiput, spinous processes, and clavicle is included, highlighting each graft's specific techniques and emphasizing the range of options available to spino-plastic surgeons. Highlights Vascularized Bone Grafts (VBGs) have emerged as a favored technique in complex spinal reconstruction. The field of spino-plastic surgery highlights the collaboration between plastic, orthopedic, and neurosurgery. The article outlines the reconstructive ladder for bony defects, with VBGs being a critical addition. Advantages of VBGs include enhanced fusion rates, lower risk of infection, and reduced operative time. Preserving the vascular supply during graft harvest is crucial. Preoperative planning is essential as VBG selection is made on a case-by-case basis.