Vascularized Thumb Metacarpal Periosteal Flap for Scaphoid Nonunion in Adolescents: A Prospective Cohort Study of 12 Patients

Méndez-Sánchez, Gerardo; Mir-Bulló, Xavier; Knörr, Jorge; Bertelli, Jayme Augusto; Soldado, Francisco

doi:10.1016/j.jhsa.2018.08.019

Cited by 14 publications

(21 citation statements)

References 31 publications

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“…This article described the anatomy, clinical applicability and some novel clinical cases on the use of VPF in common upper limb conditions. [16][17][18]25 The new VPFs presented in this article are those of the dorsal wrist and hand (4-5 radial and dorsum of the second MTC bone).…”

Section: Discussionmentioning

confidence: 99%

“…As such, in recent years, we started the study and clinical application of pediculated VPFs in upper extremity defects to obtain a surgical technique complying with the premises of technical ease, graft adaptability, osteoinductive capacity and fast integration, as well as low donor area morbidity. [16][17][18][19] Consolidation and revascularization of the bone defect were obtained in all cases, with no complications. 17 This paper summarizes and details the fundamental aspects of the surgical technique, the regional anatomy studied through cadaveric dissections, and the indications for pediculated VPFs in upper limb conditions.…”

Section: Introductionmentioning

confidence: 88%

“…[16][17][18][19] Consolidation and revascularization of the bone defect were obtained in all cases, with no complications. 17 This paper summarizes and details the fundamental aspects of the surgical technique, the regional anatomy studied through cadaveric dissections, and the indications for pediculated VPFs in upper limb conditions.…”

Section: Introductionmentioning

confidence: 88%

“…bone, between the abductor pollicis longus (APL) and extensor pollicis brevis tendon (EPB) tendons. It has a 5.2 cm-long pedicle 17,25 and, on average, it includes 12 periosteal branches 17,25 from the vascular axis of the first dorsal metacarpal artery (PDMA)(►Fig. 10).…”

Section: Periosteal Vascularized Flaps For Dorsal Wrist and Hand Anatomymentioning

confidence: 99%

“…It has an optimal size for small defects of up to 4 cm 2 . The length of its pedicle (5.2 cm) allows it to be used both for scaphoid pseudoarthrosis and/or avascular necrosis either by a volar and dorsal approach [17][18][19][20][21][22][23][24][25] . It can also be used for semilunar necrosis or Kienböck disease through a dorsal approach, although 4-5 radial VPFs are often preferred in such cases.…”

Section: Clinical Usefulnessmentioning

confidence: 99%

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Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Alabau-Rodriguez

Liburd

González

et al. 2020

Revista Iberoamericana de Cirugía de la Mano

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Massive bone defects represent a challenge in orthopedics. The structural and biological contribution of vascularized bone flaps has significantly improved their treatment. Similarly, free vascularized periosteal flaps (VPF) have been used to treat bone defects in children, with higher flexibility, adaptability to the recipient's bed and good osteogenic and osteoinductive capacity. However, these are complex techniques related to donor area morbidity. We have started anatomical and clinical studies on the application of pediculated VPF in recalcitrant massive defects to reduce this morbidity. This article summarizes the fundamental aspects of the surgical technique, the main anatomical findings from cadaveric dissections and the applicability of pediculated VPF to treat biologically unfavorable bone defects at the upper limb. The authors review the vascularized humeral periosteal flap (VHPF), the dorso-ulnar and volar-radial forearm periosteal flaps and the vascularized first metacarpal periosteal flap, all described in previous papers. As a novelty, the dorsal wrist and hand VPF (4-5 radial periosteal flap and dorsum of the second metacarpal bone periosteal flap) are presented. In addition, clinical cases with recent VPF applications in common upper limb conditions are described.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 88%

Section: Periosteal Vascularized Flaps For Dorsal Wrist and Hand Anatomymentioning

confidence: 99%

Section: Clinical Usefulnessmentioning

confidence: 99%

See 3 more Smart Citations

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Alabau-Rodriguez

Liburd

González

et al. 2020

Revista Iberoamericana de Cirugía de la Mano

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Effect of vascularized periosteum on revitalization of massive bone isografts: An experimental study in a rabbit model

et al. 2020

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Introduction In the last years, limb salvage has become the gold standard treatment over amputation. Today, 90% of extremity osteogenic sarcomas can be treated with limb salvage surgery. However, these reconstructions are not exempt from complications. Massive allografts have been associated to high risk of nonunion (12–57%), fracture (7–30%) and infection (5–21%). Association of vascularized periosteum flap to a massive bone allograft (MBA) has shown to halve the average time of allograft union in clinical series, even compared to vascularized fibular flap. Creeping substitution process has been reported in massive allograft when periosteum flap was associated. However, we have little data about whether it results into allograft revitalization. We hypothesize that the association of a periosteum flap to a bone isograft promotes isograft revitalization, defined as the colonization of the devitalized bone by new‐form vessels and viable osteocytes, turning it vital. Materials and Methods Forty‐four New Zealand white male rabbits underwent a 10 mm segmental radial bone defect. In 24 rabbits the bone excision included the periosteum (controls); in 20 rabbits (periosteum group) bone excision was performed carefully detaching periosteum in order to preserve it. Cryopreserved bone isograft from another rabbit was trimmed and placed to the defect gap and was fixed with a retrograde intramedullar 0.6 mm Kirschner wire. Rabbits were randomized and distributed in 3 subgroups depending on the follow‐up (control group: 5 rabbits in 5‐week follow up group, 8 rabbits in 10‐week follow‐up group, 7 rabbits in 20‐week follow‐up group; periosteum group: 5 rabbits in 5‐week follow up group, 7 rabbits in 10‐week follow‐up group, 7 rabbits in 20‐week follow‐up group). Fluoroscopic images of rabbit forelimb were taken after sacrifice to address union. Each specimen was blindly evaluated in optical microscope (magnification, ×4) after hematoxylin and eosin staining to qualitative record: presence of new vessels and osteocytes in bone graft lacunae (yes/no) to address revitalization, presence of callus (yes/no) and woven bone and cartilage tissue area (mm2) to address remodeling (osteoclast resorption of old bone and substitution by osteoblastic new bone formation). Results No isograft revitalization occurred in any group, but it was observed bone graft resorption and substitution by new‐formed bone in periosteum group. This phenomenon was accelerated in 5‐week periosteum group (control group: 49.5 ± 9.6 mm2 vs. periosteum group: 34.9 ± 10.4 mm2; p = .07). Remodeled lamellar bone was observed in both 20‐week groups (control group: 6.1 ± 6.3 mm2 vs. periosteum group: 5.8 ± 3.0 mm2, p = .67). Periosteum group showed complete integration and graft substitution, whereas devitalized osteons were still observed in 20‐week controls. All periosteum group samples showed radiographic union through a bone callus, whereas controls showed nonunion in eight specimens (Union rate: control group 60% vs. periosteum group 100%, p = .003). Conclus...

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Reverse radiodorsal artery‐pedicled thumb metacarpal vascularized bone graft for osteochondral fracture of the thumb interphalangeal joint with a bone defect: A case report

et al. 2020

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Osteochondral fractures of the fingers are challenging to treat, and it is mandatory to acquire early bone union and joint surface reconstruction to obtain satisfactory outcomes. These injuries sometimes occur as open fractures with poor soft tissue condition and bone defect adjacent to osteochondral fragment. For such cases, surgical treatment can be more difficult, and vascularized bone graft (VBG) could be a useful method for joint reconstruction. Here, we report reverse‐pedicled VBG based on the radiodorsal artery of the thumb for reconstructing a traumatic bone defect of the thumb. A 36‐year‐old man, who had ulcerative colitis and was taking immunosuppressive agents, sustained open fracture‐dislocation of the thumb interphalangeal joint with a free osteochondral fragment of the proximal phalanx and 6 × 5 × 4 mm of subcondylar bone defect. We harvested 5 × 5 × 5 mm VBG at the base of the first metacarpal bone and dissected running the radiodorsal artery. The vascularized bone was grafted into the bone defect site through the subcutaneous tunnel created on the radial aspect of the proximal phalanx and fixed with a Kirschner wire. Bony union was obtained 2 months after surgery. At 7 months after the operation, the patient complained no pain, and the range of motion of the thumb interphalangeal joint was extension 0° and flexion 42°. Radiographs showed no avascular necrosis of the united fragment and osteoarthritis of the interphalangeal joint. This method could be a useful option for reconstruction of the thumb with bone defects.

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Vascularized Thumb Metacarpal Periosteal Flap for Scaphoid Nonunion in Adolescents: A Prospective Cohort Study of 12 Patients

Cited by 14 publications

References 31 publications

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Effect of vascularized periosteum on revitalization of massive bone isografts: An experimental study in a rabbit model

Reverse radiodorsal artery‐pedicled thumb metacarpal vascularized bone graft for osteochondral fracture of the thumb interphalangeal joint with a bone defect: A case report

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