Vascularized thumb metacarpal periosteal pedicled flap for scaphoid nonunion: An anatomical study and pediatric case report

Méndez-Sánchez, Gerardo; Rodríguez‐Baeza, Alfonso; Knörr, Jorge; Bertelli, Jayme Augusto; Soldado, Francisco

doi:10.1002/micr.30233

Cited by 11 publications

(13 citation statements)

References 32 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%

“…Technically, they are easier to elevate because they do not require the meticulous work used in bone flaps for upper limb conditions. 17,25 On the other hand, the periosteal tissue flexibility provides an easy and quick adaptability to the receptor bed, usually allowing a complete or partial coverage of the focus to be treated; moreover, the contact surface between the VPF and the receiving bed is increased, speeding up the whole biological process related to bone flaps. 3,4,17 Fig.…”

Section: Discussionmentioning

confidence: 99%

“…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%

“…The flap and vascular pedicle were elevated after a subperiosteal dissection at the distal level, a proximal section of the periosteum and a supraperiosteal dissection up to the trapezius-metacarpal bone capsule. 25 (►Fig. 14) The flap was recovered from below the extensor pollicis brevis tendon because the scaphoid bone was approached from a volar position.…”

Section: Clinical Casesmentioning

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: Discussionmentioning

confidence: 99%

Section: Periosteal Vascularized Flaps For Dorsal Wrist and Hand Anatomymentioning

confidence: 99%

Section: Clinical Usefulnessmentioning

confidence: 99%

Section: Clinical Casesmentioning

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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Bone nonunion management in children with a vascularized tibial periosteal graft

et al. 2020

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Background: Vascularized periosteal graft have demonstrated a tremendous bone healing capacity in children. The objective is to report outcomes on the use of vascularized tibial periosteal graft (VTPG) during bone reconstruction in a series of children with complex bone healing problems. Patients and methods: Cases were collected retrospectively since May 2013 to May 2019, excluding cases of congenital pseudarthrosis of the tibia. Mean age at surgery was 12.8 (range 11-18) years. Indications included treatment of recalcitrant bone nonunion and the prevention of bone allograft-host junction nonunion in seven and three patients, respectively. The periosteal flap, based on the anterior tibial vessels, was harvested as a free flap in six instances and as a pedicled flap in four. Results: Mean follow-up was 25.2 months (range 8-36). The flap showed a 13.6 cm (range 9-16) and mean width 3.4 cm (range 2.7-3.9). Early bone union was achieved, initially through periosteal callus, followed by cortical union at mean times of 2 and 4 months, respectively, in nine cases. The flap was not successful in a patient with severe comorbidities. No donor site complications were registered. Conclusions: VTPG was fast and high effective for the treatment complex bone nonunion or the prevention of allograft nonunion in children.

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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 pedicled flap for scaphoid nonunion: An anatomical study and pediatric case report

Abstract: VTMPF may be considered a valuable and reliable surgical option for scaphoid nonunion in complex clinical scenarios.

Cited by 11 publications

References 32 publications

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Use of Vascularized Periosteal Flaps in Upper Extremity Pathology

Bone nonunion management in children with a vascularized tibial periosteal graft

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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