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Reconstruction of scaphoid

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Vascularised bone graft, Mathoulin-Kuhlmann and Zaidemberg

Published in: Health & Medicine

Reconstruction of scaphoid

  1. 1. 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
  2. 2. Introduction <ul><li>WHAT TO DO NOW ? </li></ul><ul><li>There is still no gold standard. </li></ul><ul><li>Cancellous bone </li></ul><ul><li>Bone grafts </li></ul><ul><li>Fixation (screws, K-wires, ...) </li></ul><ul><li>Vascularized bone grafts </li></ul><ul><li>... </li></ul><ul><li> </li></ul>5th Workshop on HandFlaps Only 1/3 of patients with proximal pole nonunions with avascular proximal poles achieved union when treated with iliac crest bone grafting and Herbert screw fixation. Filan & Herbert, 1996.
  3. 3. Indication <ul><li>Scaphoid nonunion </li></ul><ul><li>Avascular proximal pole </li></ul><ul><li>2nd “line of defense“ </li></ul><ul><li>... </li></ul>5th Workshop on Hand Flaps
  4. 4. Introduction 5th Workshop on Hand Flaps
  5. 5. Histor y 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
  6. 6. Histor y 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.
  7. 7. Histor y 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. »
  8. 8. Histor y 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.
  9. 9. Anatom y 5th Workshop on Hand Flaps Scaphoid Palmar Carpal Artery Radius Radial Artery Ulna Radius Scaphoid Palmar Carpal Artery Ulnar Artery Radial Artery M. Pronator Quadratus DRUJ
  10. 10. Technique Palmar Carpal Artery 5th Workshop on Hand Flaps
  11. 11. Technique 5th Workshop on Hand Flaps
  12. 12. Technique 5th Workshop on Hand Flaps FCR Radial Artery Palmar Carpal Artery
  13. 13. Technique 5th Workshop on Hand Flaps
  14. 14. Technique 5th Workshop on Hand Flaps
  15. 15. Technique 5th Workshop on Hand Flaps
  16. 16. Technique 5th Workshop on Hand Flaps
  17. 17. Technique 5th Workshop on Hand Flaps
  18. 18. Technique 5th Workshop on Hand Flaps 1 month 2 months 3 1/2 months
  19. 19. 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
  20. 20. Histor y 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
  21. 21. Histor y 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.
  22. 22. Anatom y 1,2 I nter C ompartmental S upra R etinacular A rtery [email_address] 5th Workshop on HandFlaps
  23. 23. Anatom y Hand and wrist surgery, 2008 5th Workshop on HandFlaps
  24. 24. Technique [email_address] 5th Workshop on HandFlaps
  25. 25. Technique [email_address] 5th Workshop on HandFlaps
  26. 26. Technique 5th Workshop on HandFlaps
  27. 27. Technique Hand and wrist surgery, 2008 5th Workshop on HandFlaps
  28. 28. Technique [email_address] [email_address] 5th Workshop on HandFlaps
  29. 29. Technique 5th Workshop on HandFlaps
  30. 30. Technique 5th Workshop on HandFlaps
  31. 31. Technique [email_address] 5th Workshop on HandFlaps
  32. 32. Remember : 5th Workshop on HandFlaps <ul><li>- Planing the bone size and shape </li></ul><ul><li>- The pedicle is constant ( Kuhlmann/Mathoulin ) </li></ul><ul><li>Scaphoid humpback deformity: as the loss of osseous substance is anterior, restoring the height of the scaphoid is easier ( Kuhlmann/Mathoulin ) </li></ul>
  33. 33. Take care… … not to denude the vessels of the pedicle: preserve surrounding 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
  34. 34. Thank you for your attention! … any questions? 5th Workshop on Hand Flaps

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