What is bone grafting?

Indications and Procedures

Ideally, the grafting procedure involves the transfer of bone tissue from one site to another on the same individual, which is termed an autogenous graft. This method eliminates the chance of rejection, allowing the transplantation of entire functional units of tissue: arteries, veins, and even nerves, as when a toe is used to replace a finger or thumb (toe-digital transfer). Autogenous rib or fibula grafts may be utilized for the reconstruction of the face or extremities.

Bone grafts are often used in situations in which a bone fracture is not healing properly. A fracture that fails to heal in the usual time is considered to be a delayed union. Cancellous material from the bone (the spongy inner material), usually obtained from the iliac crest of the pelvis or from the ends of the long bones, is placed around the site. The fracture must then be immobilized for several months, allowing the grafted material to infiltrate and repair the fracture.

Uses and Complications

The grafting of bone tissue is carried out to correct a bone defect, to provide support tissue in the case of a severe fracture, or to encourage the growth of new bone. The source of the skeletal defect may be congenital malformation, disease, or trauma. For example, reconstruction may be necessary following cancer
surgery, particularly for the jaw or bones elsewhere in the face.

If the autogenous bone supply is inadequate to fill the need, allogeneic bone grafts, the transplantation of bone from an individual other than an identical twin, may be necessary. Such foreign tissue is more likely to undergo rejection, reducing the chance of a successful procedure; the more closely the tissues of the two persons are matched, the less likely rejection will be a problem.

If the graft is able to vascularize quickly and to synthesize new tissue, the procedure is likely to be successful. The graft itself may provide structural support, or it may gradually be replaced by new bone at that site, completing the healing process.

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