Vascularized bone grafts for scaphoid nonunion and Kienbock's disease

The vascular anatomy of the distal radius permits fabrication of reverse-flow pedicled vascularized bone grafts, which are useful to treat disorders of the carpus. In experimental studies, reverse-flow vascularized radius grafts maintained bone blood flow for 2 weeks postoperatively and showed improved results when compared with no treatment and conventional grafts in terms of fracture healing and remodeling of necrotic bone adjacent to the graft. Pedicled vascularized bone grafts from the dorsal distal radius offer the additional advantage of a single incision for graft harvest and donor site preparation, without the potential injury to the volar carpal ligaments. Faster union times, the ability to revascularize necrotic bone, and technical ease of harvest have made these grafts clinically useful tools for treatment of some scaphoid nonunion and Kienböck's disease patients. The surgical technique, aftercare, and results summarized are superior to those obtained using conventional methods.