engleski

Pedicled vascularized bone grafts for disorders of the carpus

Pedicled vascularized distal radius bone grafts (VBG) offer a peculiar treatment option which can be used with other treatment procedures in the management of carpal disorders like: scaphoid nonunion, Preiser’s disease, or Kienböck’s disease.We present indications and different operative tehniques for four patients treated in our Department because of various carpal disorders. Two male patients with scaphoid nonunion were operated using different VBG. A 29-year old male with proximal pole nonunion was treated with capsular-based distal radius VBG. A 26-year old male, after failed Matti Russe procedure, was treated with distal radius VBG using 1, 2-intracompartmental supraretinacular artery (1, 2-ICSRA) and additional fixation with Herbert screw. The 1, 2-ICSRA graft was also used for treatment Preiser’s disease in 33-year old women. Second stage of Kienböck’s disease in 29-year old female was treated with combination of distal radius shorthening osteotomy and revascularisation with 4, 5 ICSRA VBG. In all operative procedures we used tourniquet but without exsanguination to facilitate identification of the vesels. The vascularity of the graft was confirmed during surgery with tourniquet release. Vascularized bone grafts have superior biological and mechanical properties resulting with faster and more reliably healing than nonvascularized grafts. They also bring osteogenic and angiogenic factors into site of avascular necrosis that facilitate revascularization and bone remodeling of the avascular segment or whole bone. VBGs therefore represent a unique option of biological reconstruction which can be used in a specific cases in order to preserve the integrity of the carpal bones and avoid salvage procedures, which are characterized by significantly poorer functional results, that can be extremely important in young, active patients.

vascularised bone graft, carpal bones

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