BONE AND SOFT TISSUE DEFECTS: A CRITICAL REVIEW OF FREE FLAPS, BONE GRAFTS, AND 3D TECHNOLOGIES IN MUSCULOSKELETAL RECONSTRUCTION

Abstract

DOI: https://doi.org/10.46296/gt.v9i17.0341

Abstract

Introduction: Large bone and soft tissue defects – often due to high-energy trauma, infections, or tumor resection – pose a major clinical challenge. Musculoskeletal reconstruction aims to restore anatomical and functional integrity, avoiding amputation and improving patient outcomes (1). Historically, bone grafts (autografts and allografts) and free tissue flaps have been used to replace lost tissues; more recently, 3D technologies offer potential to customize implants and enhance results. Objective: To critically review the past decade’s literature on key reconstructive strategies – free flaps, traditional bone grafts, and emerging techniques like 3D printing – evaluating their indications, advantages, limitations, and current evidence in managing large musculoskeletal defects. Methods: A search was conducted in PubMed, Scopus, and Embase for human studies (2015–2025) on post-traumatic bone and soft tissue reconstruction, prioritizing systematic reviews, meta-analyses, clinical trials, and significant series. Results: Microvascular free flaps demonstrate high success rates (>90%) in covering complex defects (4, 5), reducing infections and need for amputation. Autologous bone grafts remain the cornerstone of bone repair due to superior osteogenic potential (1), though limited by donor site morbidity. Allografts enable reconstruction of larger segments but carry higher risks of non-union and infection (1). Techniques like bone transport (distraction osteogenesis) and the induced membrane (Masquelet) achieve union in ~80–90% of select cases (6, 7) at the expense of prolonged treatment. 3D technologies have improved surgical planning accuracy (17) and allowed fabrication of patient-specific implants with complete bone integration in small series (18), though their role is still under evaluation. Conclusions: Major musculoskeletal reconstruction requires an individualized, multidisciplinary approach. Autologous grafts (including vascularized free flaps) remain first-line due to high osteointegration and tissue viability. Free flaps for soft tissue are critical to cover large defects and prevent infection. Advances in biomaterials and 3D printing promise tailored solutions that could complement or enhance current techniques, but further clinical studies are needed to define their long-term impact.

Keywords: Free flaps; Bone graft; Musculoskeletal reconstruction; 3D printing; Trauma; Bone defect.