Medial Femoral Condyle Microvascular Bone Transfer as a Treatment for Capitate Avascular Necrosis: Surgical Technique and Case Report

Kazmers, Nikolas H.; Rozell, Joshua C.; Rumball, Kevin M.; Kozin, Scott H.; Zlotolow, Dan A.; Levin, L. Scott

doi:10.1016/j.jhsa.2017.04.006

Cited by 21 publications

(17 citation statements)

References 17 publications

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“…3 However, in the early stage, as in the present case, without capitate collapse, in which osteonecrotic changes could only be identified on MRI, curettage followed by conventional or vascularized bone grafting is desirable from the perspective of preserving joint range of motion. 2,3,5 Indeed, among the past case reports, early-stage treatment by vascularized bone grafting following partial bone excision or curettage achieved excellent results without significant loss of range of motion. 1,2,6 To evaluate the process of osteonecrosis, imaging tests were usually used, but arthroscopy has recently been found to be useful for direct evaluation of the articular cartilage or chondral defect.…”

Section: Discussionmentioning

confidence: 99%

“…2,3,5 Indeed, among the past case reports, early-stage treatment by vascularized bone grafting following partial bone excision or curettage achieved excellent results without significant loss of range of motion. 1,2,6 To evaluate the process of osteonecrosis, imaging tests were usually used, but arthroscopy has recently been found to be useful for direct evaluation of the articular cartilage or chondral defect. 9 Several donor sites have been described for vascularized bone grafting, but an ideal donor site has the following important conditions: adequate quantity of bone, sufficient length of the flap pedicle, constant pedicle anatomy without variations, low donor site morbidity, and harvest within the same operative field if possible.…”

Section: Discussionmentioning

confidence: 99%

“…3 Surgical treatment consists of arthrodesis, proximal capitate resection, interposition plasty, prosthesis, curettage and bone grafting, and denervation. 2,3,9 In the advanced stage that demonstrates collapse of the capitate on imaging, arthrodesis, partial resection, prosthesis, and denervation surgeries are appropriate for pain relief. 3 However, in the early stage, as in the present case, without capitate collapse, in which osteonecrotic changes could only be identified on MRI, curettage followed by conventional or vascularized bone grafting is desirable from the perspective of preserving joint range of motion.…”

Section: Discussionmentioning

confidence: 99%

“…Osteonecrosis of the capitate is a rare condition that may be idiopathic or the result of posttraumatic avascular change, and there are a few reports of the outcomes of surgical treatment. [1][2][3] For treatment in the early stage of necrosis without bone or cartilage collapse, vascularized bone grafting has achieved reliable outcomes, 1,2,[4][5][6] but there are several disadvantages of each donor site. The dorsal surface of the radius based on the fourth extensor compartment artery (4th ECA) 1,4 and the 2,3 intercompartmental supraretinacular artery (2,3 ICSRA) 5 are reasonable donor sites, but these bone grafts need a long longitudinal incision for flap elevation.…”

Section: Introductionmentioning

confidence: 99%

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Vascularized Second Metacarpal Bone Graft for the Treatment of Idiopathic Osteonecrosis of the Capitate

Usami

Kawahara

Inami

2019

Hand (New York, N,Y.)

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Background: Idiopathic osteonecrosis of the capitate is rare condition with few reports of treatment using vascularized bone graft. Methods: A case of a 45-year-old woman with idiopathic necrosis of the capitate who underwent surgical treatment with a vascularized bone graft from the base of the second metacarpal bone is reported. Results: At 14 months postoperatively, the range of motion of her wrist was maintained, and localized wrist pain was relieved. Conclusions: This bone graft, which has a reliable pedicle with few anomalies, offers sufficient cancellous bone for the capitate, and can be harvested in the same operative field, is desirable for the treatment of osteonecrosis of the capitate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Vascularized Second Metacarpal Bone Graft for the Treatment of Idiopathic Osteonecrosis of the Capitate

Usami

Kawahara

Inami

2019

Hand (New York, N,Y.)

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“…These branches of the articular network of the knee are already widely used for reconstructive procedures: (i) as cutaneous flaps with the SLGA as source vessel (Laitung, 1989;Hayashi & Maruyama, 1990a;Spokevicius & Jankauskas, 1995;Taniguchi et al 2009); (ii) as pure corticoperiosteal flaps (Hertel & Masquelet, 1989) or with additional skin flaps. In these procedures, the source vessel is either the DGA (Guan et al 1985;Martin et al 1991;Sakai et al 1991;Kobayashi et al 1994;Doi et al 2000;Muramatsu et al 2003;Fuchs et al 2005;Bakri et al 2008;Cavadas & Landin, 2008;Gaggl et al 2008;Jones et al 2008Jones et al , 2010Kalicke et al 2008;Doi & Hattori, 2009;Dubois et al 2010;Pelzer et al 2010;Kakar et al 2011;Rahmanian-Schwarz et al 2011;Iorio et al 2012;Higgins & Burger, 2014;Kazmers et al 2017;Tremp et al 2017) or the SLGA (Higgins & Burger, 2014;Wong et al 2015;Morsy et al 2018).…”

Section: Introductionmentioning

confidence: 99%

Vascular coverage of the anterior knee region – an anatomical study

2019

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Descriptions of vessel angiosomes or perforasomes throughout the human body are quite frequent, and led to the development of flaps nowadays commonly used to surgically cover skin and soft tissue defects. In these procedures, the surgeon requires a profound anatomical knowledge of the respective blood vessels and the extent of the perfused area to define the size of the graft. In the region of the knee joint, descriptions of flaps based on the superior lateral genicular artery and descending genicular artery are quite frequent. In contrast, information regarding other popliteal branches is scarce or non‐existent. The aim of this study was to provide a concise and complete overview on the extent and variability of the perforator angiosomes of the femoral and popliteal arteries in the anterior knee region. Twenty lower extremities were dissected, the respective perforators identified and perfused with dye. All resulting angiosomes were marked and documented. A total of 84 angiosomes were identified in all specimens, with an average of 4.2 (3–6) angiosomes per specimen. The average size of the angiosomes was 97.04 ± 72.30 cm 2 (8.61–360.41 cm 2 ), their source vessels had an average diameter of 1.42 ± 0.54 mm (0.60–3.25 mm). The complex and highly variable distribution of perforator angiosomes of the anterior knee region and especially of its less frequently investigated distal part was demonstrated. Based on these results, the planning of existing perforator flaps in this region and the development of flaps including the inferior medial or inferior lateral genicular arteries may be facilitated.

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Periosteal medial femoral condyle free flap for metacarpal nonunion

et al. 2021

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Background: Metacarpal nonunion is a rare condition. The osteogenic capacity of periosteal free flap was investigated in five patients with metacarpal nonunion and impaired bone vascularization.Patients and methods: Surgery was performed between 64 and 499 days after the initial bone osteosynthesis. The average age was 27.6 (range 16-32) years. Nonunion was caused by excessive periosteal removal in two patients, extensive open trauma in three. Four nonunions were diaphyseal, one metaphyseal. A periosteal medial femoral condyle free flap was raised on the descending genicular artery for four patients, the superomedial genicular artery for one. After osteosynthesis with a plate, the flap was wrapped around the metacarpal, overlapping the bone proximally and distally.The recipient vessel were the dorsal branch of the radial artery and a vena comitans in the anatomical snuffbox in four patients, at the base of the first webspace in one. Results:The flap size ranged from 5 Â 3.5 cm to 8 Â 4 cm. No postoperative complication occurred. Radiological bone union was achieved 3 to 8 months after surgery.One patient had a full range of motion, one a slight extension lag of the proximal interphalangeal joint, two moderate joint stiffness of the proximal interphalangeal or metacarpophalangeal joint (one requiring plate removal and extensor tenolysis), one severe stiffness that allowed using a hook grip which was the aim of the surgery. Conclusion:In case of metacarpal nonunion with impaired bone vascularization, the periosteal medial femoral condyle free flap provides an effective and biomimetic approach to bone healing.

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Medial Femoral Condyle Microvascular Bone Transfer as a Treatment for Capitate Avascular Necrosis: Surgical Technique and Case Report

Cited by 21 publications

References 17 publications

Vascularized Second Metacarpal Bone Graft for the Treatment of Idiopathic Osteonecrosis of the Capitate

Vascularized Second Metacarpal Bone Graft for the Treatment of Idiopathic Osteonecrosis of the Capitate

Vascular coverage of the anterior knee region – an anatomical study

Periosteal medial femoral condyle free flap for metacarpal nonunion

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