What is a pedicled bone graft? Our 12 year-old son is going to need a bone graft for a bad fracture that just never healed. Now they say it’s a nonunion — there’s a big gap between the two ends of the fractured bone. A pedicled bone graft has been recommended. They are going to take the bone from the smaller bone in the lower leg. So back to the original question: what is that exactly?

Children have remarkable healing abilities but sometimes their fast growth just isn’t enough. That’s the case with large gaps in bone caused by tumor removal or traumatic fractures. To help bridge the gap, a special technique called vascularized fibular periosteal graft can be used.

A fibular periosteal flap is a piece of bone taken from the fibula the smaller bone in the lower leg. A special tool called a periosteal elevator is used to lift the top layer of bone, which is then transferred to the site where it is needed.

The way in which the bone graft is placed in the defect depends on the underlying problem. For example, if a fracture hasn’t healed (called a nonunion), then the periosteal flap is wrapped around the two ends of the bone in a “J” pattern. If the gap is from bone (tumor) removal, then the flap is used to bridge the gap by attaching it from one side to the other.

If the bone is used in the same leg, then blood vessels to the bone can be taken at the same time. This is called a pedicled graft. If the bone graft is used anywhere else, the donor bone is taken without attached blood vessels (called a free flap). With a free flap, the surgeon must perform microsurgery to connect the bone graft to local blood vessels (at the site of placement).

Vascularized fibular periosteal graft is a reconstructive strategy that works for children because of their unique ability to grow fast. This type of tissue transfer is successful because the bone has strong osteogenic (bone growth) properties and angiogenic (formation of blood vessels) abilities. Both the donor site and the graft site heal quickly and without problems.