Vascularized Olecranon Bone Graft: An Anatomical Study and Novel Technique
| Autor: | David D. Rivedal, Hani S. Matloub, Lucas M. Boehm, Ji-Geng Yan, Kai Yang |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Olecranon
Ulna Free flap 030230 surgery Iliac crest 03 medical and health sciences 0302 clinical medicine medicine.artery medicine Cadaver Humans Orthopedics and Sports Medicine Olecranon Process 030222 orthopedics Posterior ulnar recurrent artery Periosteum Bone Transplantation business.industry Flexor carpi ulnaris muscle Anatomy Forearm medicine.anatomical_structure Surgery Cadaveric spasm business Cancellous bone |
| Zdroj: | The Journal of hand surgery. 45(2) |
| ISSN: | 1531-6564 |
| Popis: | Purpose Autologous bone grafting is commonly used in reconstructive hand surgery. Various sources of nonvascularized autologous bone grafts have been described in the literature. However, in some situations, a vascularized bone graft may be needed. Popular vascularized bone grafts are taken from the distal radius, iliac crest, and medial femoral condyle. The purpose of this study was to examine the feasibility of harvesting a free vascularized bone flap from the proximal ulna. Methods Latex was injected via the brachial artery to facilitate visualization of perforators in 10 cadaveric specimens. Dissections were performed of the olecranon; all periosteal perforators were noted, and their lengths and diameters recorded. Corticocancellous bone flaps with their supplying pedicles were harvested. Three additional fresh specimens were injected with india ink via the pedicles to demonstrate perfusion of the harvested bone flap. Results Consistent vascular anatomy supplied the olecranon. A perforator from the posterior ulnar recurrent artery supplied the proximal ulna and olecranon, from which a vascularized bone flap can be harvested. Branches to the flexor carpi ulnaris muscle may allow chimeric flaps to be harvested. Average pedicle length was 5.8 cm and average pedicle diameter was 2.4 mm. India ink injection of the pedicles showed perfusion of the periosteum as well as intraosseous cancellous bone. Conclusions A vascularized olecranon free flap can be harvested based on the posterior ulnar recurrent artery. Vascular anatomy is consistent and flap harvest is simple and straightforward in all cadaveric specimens. Clinical relevance A vascularized olecranon free flap represents a potential new surgical option when vascular bone flap reconstruction is considered. |
| Databáze: | OpenAIRE |
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