Vascularized bone grafting from the volar distal radius for carpal bones reconstruction

We report the use of vascularized bone graft harvested from the volar aspect of distal radius for carpal bone reconstruction. This transplant is known and used since 1965, but the technical description of reliable harvesting more recent is presented. The anatomical dissection of 30 corpses found in a constant way the presence of the transverse carpal artery which born from radial artery. This vascularized bone graft was used for the treatment of 112 scaphoid nonunion with an average follow-up of 27.82 months (10-107). Union was obtained in 95.54% of the cases with an average of 6.7 weeks (6-9). We report also the result of this vascularized bone graft for the revascularization of the lunatum in 22 patients with Kienbock's disease with an average follow-up of 74 months (60-124). The postoperative MRI control with a minimum of 8 months showed 17 healing, three stabilizations of lesions and two failures requiring a secondary palliative surgery. The use of a vascularized transplant harvested from the volar aspect of distal radius is now a well codified, meticulous but reliable and sure technique, which requires a single approach for the reconstruction of some carpal bones (scaphoid, lunatum) allowing a locoregional anesthesia and an outpatient basis. (C) 2010 Elsevier Masson SAS. All rights reserved.