reconstruction of scaphoid

3rd Workshop on Hand Flaps 31.01.-01.02.2007

Palmar pedicled vascularized bone flap of the radius(Kuhlmann/Mathoulin)

5th Workshop on Hand Flaps

04. - 05.02.2009

Dr. I. Tami

Division of Plastic Surgery and Hand Surgery,

University Hospital Zürich


Introduction

WHAT TO DO NOW ?

There is still no gold standard.

Cancellous bone Bone grafts Fixation (screws, K-wires, ...) Vascularized bone grafts ...

5th Workshop on HandFlaps

Only 1/3 of patients with proximal polenonunions with avascular proximal polesachieved union when treated with iliac crest bone grafting and Herbert screw fixation.

Filan & Herbert, 1996.


Indication

Scaphoid nonunion

Avascular proximal pole 2nd “line of defense“ ...



Introduction


History

1965 palmar tubercle of scaphoid

1983 palmar distal radius

1987 free iliac crest

1991 dorsal distal radius

2000 free medial femoral condyle

2003 second metacarpal base


History








Kuhlmann J.N., Minoun M., Boabighi A., Baux S.

Vascularised bone graft pedicled on the volar carpal artery for non-union of the scaphoid.

J Hand Surg (Br) 1987; 12-B(2): 203-210.

History








Mathoulin C., Haerle M.

Vascularised bone graft from the palmar carpal artery for treatement of scaphoid nonunion.

J Hand Surg (Br) 1998; 23-B(3): 318-323.

«HARVESTING THE VASCULARIZED BONE

GRAFT WAS A RELATIVELY DIFFICULT

AND DELICATE PROCEDURE IN ALL

CASES.»

History








Fairbank S., Papadogeorgou E., Mathoulin C.

Indications and outcomes of volar vascularised bone grafts for scaphoid nonunion.

FESSH, Poznan (Pl), 3-6 June 2009.


Anatomy


Ulna Radius

Scaphoid

Palmar Carpal Artery

Ulnar Artery

Radial Artery

M. Pronator Quadratus

DRUJ

Scaphoid


Radius

Radial Artery


Technique




Technique


FCR

Radial Artery



Technique



Technique


1 month 2 months 3 1/2 months


Dorso-radial pedicled vascularized bone flap of the radius(Zaidemberg)


04. - 05.02.2009

Dr. I. Tami

Division of Plastic Surgery and Hand Surgery,

University Hospital Zürich


History









History








Zaidemberg C., Siebert J.W., Angrigiani C.

A new vascularized bone graft for scaphoid nonunion.

J Hand Surg (Am) 1991; 16: 474-478.


Anatomy

1,2 Inter Compartmental Supra Retinacular Artery

Mayo@2000



Anatomy

Hand and wrist surgery, 2008



Technique

Mayo@2000



Technique



Technique

Hand and wrist surgery, 2008



Technique

Mayo@2000 Mayo@2000



Technique



Technique

Mayo@2000



Remember :


- Planing the bone size and shape

- The pedicle is constant (Kuhlmann/Mathoulin)

- Scaphoid humpback deformity: as the loss of osseous substance is anterior, restoring the height of the scaphoid is easier (Kuhlmann/Mathoulin)


Take care…

… not to denude the vessels of the pedicle: preservesurrounding soft tissue to keep venous drainage

… not to detach the periosteum from the bone

… carefully close the extrinsic anterior carpal ligaments to prevent instability (Kuhlmann/Mathoulin)



Thank you for your attention!

…any questions?


reconstruction of scaphoid

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