Lunate Resection and Vascularized Os Pisiform Transfer in Kienböck’s Disease: An Average of 10 Years of Follow-Up Study After Saffar’s Procedure

Daecke, W.; Lorenz, Sebastian; Wieloch, Peter; Jung, Monika; Martini, Abdul Kader

doi:10.1016/j.jhsa.2005.02.015

Cited by 44 publications

(30 citation statements)

References 28 publications

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“…Daecke et al 37 reported the results of long-term follow-up on 23 patients with stages 2 and 3 disease treated with a pedicled pisiform vascularized graft. At 12-year follow-up, the mean DASH score was 15 and the mean Cooney score was 82, and 15 out of 22 patients did not experience disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…[26][27][28][29][30][31] From the dorsal aspect of the wrist, the extensor compartmental vascularized distal radius 32,33 and the vascularized metacarpal base based on the dorsal carpal artery 34,35 can be found. From the palmer aspect, vascularized os pisiform transfer 36,37 and distal radius transfer based on the palmer carpal artery 38,39 are available. In this article, we evaluated functional and radiological outcomes of vascularized bone grafts for stage 2 and 3 Kienböck disease.…”

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confidence: 99%

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Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease

et al. 2016

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Previous literatures described various methods of treatment for Kienböck disease depending on the patient characteristics, the severity of the symptom, and radiological staging. 1-8 Treatment options range from conservative measurements to surgical interventions. 9-12 Several authors advocated a biomechanical approach to reduce load transmission on the necrotic lunate, [13][14][15][16][17][18][19] and good clinical results have been reported in joint leveling procedures such as radial shortening or ulnar lengthening 20-22 and in radial or ulnar wedge osteotomy. 23,24 Hori et al 25 introduced a biological approach of revascularization for necrotic bones based on their experimental results. Since then, there have been several donor sites available for vascularized bone graft in the treatment of AbstractPurpose The objective of this article is to evaluate functional and radiological outcomes of vascularized bone grafts for stage 2 and 3 Kienböck disease. The outcomes of three different donor sites via dorsal approach of the wrist were compared. Pearls and pitfalls in surgical technique were discussed. Methods There were 28 patients who underwent vascularized bone grafts, including the extensor fourth and fifth compartmental artery graft of distal radius in 8 patients, the first and second supraretinacular intercompartmental artery graft of distal radius in 12 patients, and the second dorsal metacarpal neck graft in 8 patients. Average age was 32 years, and radiological grading according to Lichtman classification was stage 2 in 8 patients, stage 3A in 10 patients, and stage 3B in 10 patients. Temporary pinning fixing the midcarpal joint was conducted for 10 weeks postoperatively. Results Follow-up periods averaged 70 months. Pain reduced in 27 patients, and visual analog scale for pain of pre-and postoperative level averaged 59 and 18. Range of wrist flexion and extension motion improved from 87 to 117 degrees, and average grip strength improved from 21 kg preoperatively to 33 kg postoperatively. Carpal height ratio had almost no change from 0.52 to 0.53. Fragmentation of necrotic bone healed in 7 of the 14 cases. Comparative analyses of functional and radiological outcomes between three donor sites found no significant difference. Conclusion Three different vascularized bone grafts from the dorsal wrist and hand area demonstrated favorable and comparable functional outcomes. It was technically important to elevate vascular bundle with surrounding retinaculum or fascia, to include sufficient periosteum, and to insert the vascularized bone as the cortex aligned longitudinally.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease

et al. 2016

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“…26 For the lunate, apart of the pedicled grafts from the distal radius (dorsal 27,28 or palmar 29 ) or the metacarpals, [30][31][32] other procedures have been also described, ranging from the implantation of a vascular pedicle into the bone 33 to the replacement of the lunate with the vascularized pisiform. 34,35 For metacarpal and phalangeal reconstruction, simple or combined pedicled grafts may be used, from the metacarpals 36,37 (Fig. 2b) or the radius, 38 whereas for metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints, reconstruction with pedicled vascularized (MCP, PIP, and DIP) joints from the same (DIP to PIP) or neighboring digits has been described.…”

Section: Discussionmentioning

confidence: 99%

Donor sites for pedicled skeletal grafts of the hand, wrist, and forearm

Dailiana¹,

Malizos²,

Varitimidis³

et al. 2009

Microsurgery

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Pedicled bone and periosteal grafts provide successful reconstruction of skeletal problems of the distal radius, wrist, and hand. The purpose of this study was to evaluate the available alternatives and to propose the most suitable skeletal grafts for the reconstruction of the distal radius, and the carpal and hand bones. The alternative donor sites (dorsal and palmar distal radius, and metacarpals), their pedicles, and the potential coverage area in relation to specific wrist and hand pathology were determined in the cadaveric dissections. In the clinical setting, 75 pedicled grafts were used for the treatment of scaphoid nonunions (62 cases), lunate necrosis (8 cases), reconstruction of the metacarpal defects (2 cases), and wrist fusions (3 cases). All alternatives have the advantage of a single approach that may be performed under tourniquet control, from the same team. Among the available alternatives, surgeon's familiarity plays the most important role for the final selection of the graft.

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“…The first technique involved lunate resection and vascularized pisiform transfer (average follow-up of 10 y), and the alternative procedure used the pisiform to reinforce the necrotic lunate (average follow-up of 12 y). 27 The small numbers compromise any attempt at comparison between the groups.…”

Section: B Carpalsmentioning

confidence: 99%

Vascularized Bone Grafts for Upper Limb Reconstruction: Defects at the Distal Radius, Wrist, and Hand

Malizos

Dailiana

Innocenti

et al. 2010

The Journal of Hand Surgery

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Lunate Resection and Vascularized Os Pisiform Transfer in Kienböck’s Disease: An Average of 10 Years of Follow-Up Study After Saffar’s Procedure

Cited by 44 publications

References 28 publications

Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease

Vascularized Bone Grafts from the Dorsal Wrist for the Treatment of Kienböck Disease

Donor sites for pedicled skeletal grafts of the hand, wrist, and forearm

Vascularized Bone Grafts for Upper Limb Reconstruction: Defects at the Distal Radius, Wrist, and Hand

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