Recipient Vessels: Humerus Reconstruction

Reconstruction of upper extremity bone defects has evolved over the years, and the standard of care to achieve the most optimal outcomes is vascularized bone. While the most optimal donor site may be an area of debate, the fibula represents the preferred donor site as the fibula provides ample bone length and bone stock, with reliable anatomy and sufficiently size caliber vessels for microvascular anastomoses. Further, the fibula also can provide a soft tissue component in the setting that soft tissue is also needed for the reconstruction. Given the limited available recipient vessels in the upper arm, the brachial artery represents the most consistent option to perfuse the free fibula flap. However, consideration for orientation and positioning is critical to achieving the most optimal outcomes as vascularized bone is superior to allograft or bone graft in achieving bony union.