reconstruction of scaphoid
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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
3rd Workshop on Hand Flaps 31.01.-01.02.2007
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.
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Indication
Scaphoid nonunion
Avascular proximal pole 2nd “line of defense“ ...
5th Workshop on Hand Flaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Introduction
5th Workshop on Hand Flaps
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
5th Workshop on Hand Flaps
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
5th Workshop on Hand Flaps
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
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
5th Workshop on Hand Flaps
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
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
5th Workshop on Hand Flaps
Fairbank S., Papadogeorgou E., Mathoulin C.
Indications and outcomes of volar vascularised bone grafts for scaphoid nonunion.
FESSH, Poznan (Pl), 3-6 June 2009.
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Anatomy
5th Workshop on Hand Flaps
Ulna Radius
Scaphoid
Palmar Carpal Artery
Ulnar Artery
Radial Artery
M. Pronator Quadratus
DRUJ
Scaphoid
Palmar Carpal Artery
Radius
Radial Artery
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
Palmar Carpal Artery
5th Workshop on Hand Flaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on Hand Flaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on Hand Flaps
FCR
Radial Artery
Palmar Carpal Artery
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on Hand Flaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on Hand Flaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on Hand Flaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on Hand Flaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on Hand Flaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on Hand Flaps
1 month 2 months 3 1/2 months
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Dorso-radial pedicled vascularized bone flap of the radius(Zaidemberg)
5th Workshop on Hand Flaps
04. - 05.02.2009
Dr. I. Tami
Division of Plastic Surgery and Hand Surgery,
University Hospital Zürich
3rd Workshop on Hand Flaps 31.01.-01.02.2007
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
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
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
5th Workshop on HandFlaps
Zaidemberg C., Siebert J.W., Angrigiani C.
A new vascularized bone graft for scaphoid nonunion.
J Hand Surg (Am) 1991; 16: 474-478.
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Anatomy
1,2 Inter Compartmental Supra Retinacular Artery
Mayo@2000
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Anatomy
Hand and wrist surgery, 2008
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
Mayo@2000
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
Mayo@2000
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
Hand and wrist surgery, 2008
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
Mayo@2000 Mayo@2000
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Technique
Mayo@2000
5th Workshop on HandFlaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Remember :
5th Workshop on HandFlaps
- 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)
3rd Workshop on Hand Flaps 31.01.-01.02.2007
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)
5th Workshop on Hand Flaps
3rd Workshop on Hand Flaps 31.01.-01.02.2007
Thank you for your attention!
…any questions?
5th Workshop on Hand Flaps
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