The Vascularity and Osteogenesis of a Vascularized Flap for the Treatment of Scaphoid Nonunion: The Pedicle Volar Distal Radial Periosteal Flap

Tanner, Cary; Johnson, Toby; Majors, Alex; Hentz, Vincent R.; Husak, Lisa; Gallego, Edward Walker; Christ, Brad; Hoekzema, Nathan

doi:10.1177/1558944717751191

Cited by 7 publications

(5 citation statements)

References 45 publications

(78 reference statements)

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“…Vascularized periosteal flaps with pedicles are also considered an effective treatment method for scaphoid nonunion (Barrera‐Ochoa et al, 2020; Tanner et al, 2019). Barrera‐Ochoa et al (2020) reported a healing rate of 97% (31 of 32 patients) in the treatment of adult scaphoid nonunion using metacarpal periosteal flaps, with no donor site complications.…”

Section: Discussionmentioning

confidence: 99%

Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion

Chen,

Wang,

Tang

2023

Microsurgery

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BackgroundFree vascularized bone grafting (FVBG) has become one of the essential methods for treating scaphoid nonunion complicated by avascular necrosis. However, commonly used bone graft, including the medial femoral condyle bone graft and iliac crest bone graft, still present challenges such as a high rate of donor site complications and variations of vascular pedicle. In this study, we have introduced a novel bone graft—the lateral humeral condyle bone graft with the posterior branch of the radial collateral artery (PBRCA) as the vascular pedicle—as an alternative option, with the aim of overcoming some of the limitations of previously described FVBG procedures.MethodsNine patients who had a nonunion of the scaphoid that had been present for an average of 16.8 months (range 9–35 months) were managed with use of a free vascularized bone graft obtained from the lateral humeral epicondylar region. Avascularity of the scaphoid, as assessed on preoperative magnetic resonance imaging and intraoperative bone marrow puncture test. Postoperatively, regular X‐ray and CT scans examinations were conducted to assess the progress of fracture healing. Active motion of the wrist, and grip strength recovery were measured periodically. Wrist pain was graded using the Visual Analogue Scale (VAS), while wrist joint functionality was evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick‐DASH) questionnaire and the Patient‐Rated Wrist Evaluation (PRWE) scale. The elbow functional outcome was evaluated by the Mayo Elbow Performance Score (MEPS).ResultsAll of nine lateral humeral epicondylar bone grafts were successfully harvested. The blood supply of the graft during surgery was excellent in six cases and good in three cases. The size of the bone grafts ranges from 1.0 cm × 0.5 cm × 0.5 cm to 2.0 cm × 1.0 cm × 0.5 cm. The average vascular pedicle length was 3.4 cm (range 2.0–6.0 cm). There were no early complications in either the donor or recipient areas after surgery. Union was successfully achieved in all nine patients, with an average time to union of 14.3 weeks (range 11–20 weeks) after surgery. The average follow‐up period was 31.2 months (range 26–40 months). At the final follow‐up, the average palmar flexion, dorsal extension, radial deviation, and ulnar deviation angles of the injured wrist joint were 56.1° (range 45°–70°), 56.1° (range 40°–80°), 10.6° (range 5°–20°), and 22.2° (range 15°–35°), respectively, which reached 79.0%, 82.1%, 59.4%, and 72.8% of the average activity of the contralateral normal side. The average grip strength of the injured side was 35.2 kg (range 22–51 kg), which was equivalent to 81.3% of the average grip strength of the contralateral side. The average VAS score for wrist joint pain was 1.0 point (range 0–2 points); the Quick‐DASH score was 9.2 points (range 6–18 points); and the PRWE score was 13.1 points (range 9–16 points), the Mayo Elbow Performance Index was 100 points (range 100–100 points). One patient reported a feeling of friction during movement but no pain. One patient reported numbness in the donor site. One patient complained of pain when applying force to the scar in the donor area. During the follow‐up period, these complications showed improvement without any treatment.ConclusionThe FVBG technique has been considered an effective method for treating scaphoid nonunion with avascular necrosis. Compared to traditional FVBG, the lateral humeral epicondylar bone graft exhibits a higher union rate, fewer complications, and easier accessibility, making it a favorable choice.

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Section: Discussionmentioning

confidence: 99%

Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion

Chen,

Wang,

Tang

2023

Microsurgery

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“…31 The cambium layer is involved in the remodeling of bone after bone injury and stimulates vascularization of necrotic bone segments. [31][32][33] The osteogenic capacity of periosteum is supported by animal studies in which an autograft with periosteum resulted in more bone formation and better vascularization than grafts without periosteum. 34,35 The obvious problem in reducing the amount of periosteum is that it contains the vascular pedicle in VBGs.…”

Section: Discussionmentioning

confidence: 99%

Symptomatic Heterotopic Bone Formation after 1,2 ICSRA in Scaphoid Nonunions

et al. 2023

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Background We observed several cases of heterotopic bone formation after a 1,2 intercompartmental supraretinacular artery (1,2 ICSRA) distal radius vascularized bone graft (VBG) for the treatment of scaphoid nonunion. This adverse event seems underreported. Knowledge about factors associated with the formation of heterotopic bone after VBGs might help reduce this adverse event. Purpose What factors are associated with resected heterotopic bone formation after 1,2 ICSRA distal radius graft for the treatment of scaphoid nonunion? Patients and Methods We retrospectively reviewed all patients with a scaphoid nonunion treated with a 1,2 ICSRA distal radius graft between 2008 and 2019 in an urban level 1 trauma center in the Netherlands. We included 42 scaphoid nonunions in 41 people treated with the 1,2 ICSRA graft. We assessed potential correlation with patient, fracture, and treatment demographics. Results Heterotopic bone developed in 23 VBGs (55% [23/42]), of which 5 (12% [5/42]) were resected. Heterotopic bone was located radially (at the pedicle side) in all participants. Except a longer follow-up time (p = 0.028), we found no variables associated with the development of heterotopic bone formation. Conclusion The location of the heterotopic bone at the pedicle site in all cases suggests a potential association with the periosteal strip. Surgeons might consider not to oversize the periosteal strip as a potential method to prevent heterotopic ossification after VBG. Level of Evidence Level II, prognostic study.

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“…In fact, numerous studies have used human cadavers to better understand perforator anatomy and to develop novel flaps for reconstruction. 48 – 51 In addition, the beneficial use of cadavers for flap elevation and recipient vessel harvest has led to the popularization of various flap reconstruction courses.…”

Section: Simulation In Microsurgerymentioning

confidence: 99%

“…A few prosthetic models have also been developed. One such example is a synthetic breast augmentation model, complete with anatomic landmarks and a submuscular plane that was developed by Kazan et al 51 in Montreal, Canada. To overcome the issues with reusability, the authors were able to develop a strip of “skin” that would be placed over the previous incision and Velcro that would be reapplied after performing the breast pocket dissection.…”

Section: Simulation In Esthetic Surgerymentioning

confidence: 99%

Use of Simulation in Plastic Surgery Training

Agrawal

Turner

Grome

et al. 2020

Plastic and Reconstructive Surgery - Global Open

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The nationwide focus on patient safety and the health of residents has increased the demand for educational tools outside the operating room. Simulation is a valuable tool for assessing and developing surgical skills in a controlled and safe environment. The use of simulation as a formal component of training has been increasing in various surgical subspecialties. In general surgery, simulation examinations such as the Fundamentals of Laparoscopic Surgery and Fundamentals of Endoscopic Surgery have become a prerequisite to board certification. Although formal simulation examinations in plastic surgery are not universal, there has been an increase in the use of simulation to increase resident competency in the operating room. For now, we will review the current state of simulation in craniofacial, hand, microvascular, and esthetic surgery and discuss applications for the future. We will also discuss the evolving role of artificial intelligence, virtual reality, and augmented reality in plastic surgery training and testing.

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The Vascularity and Osteogenesis of a Vascularized Flap for the Treatment of Scaphoid Nonunion: The Pedicle Volar Distal Radial Periosteal Flap

Abstract: Previously proposed vascularized periosteal flaps from the distal radius appear to possess notable osteogenic potential that may be of interest to surgeons treating scaphoid nonunion.

Cited by 7 publications

References 45 publications

Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion

Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion

Symptomatic Heterotopic Bone Formation after 1,2 ICSRA in Scaphoid Nonunions

Use of Simulation in Plastic Surgery Training

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