The vascular basis of the hemi-hamate osteochondral free flap. Part 2: surgical anatomy and clinical application
| Autor: | Warren M. Rozen, Vachara Niumsawatt, Edmund W. Ek, James Leong |
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| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty medicine.medical_treatment Free flap Sampling Studies Surgical Flaps Condyle Pathology and Forensic Medicine Surgical anatomy Finger Injuries Preoperative Care medicine Humans Radiology Nuclear Medicine and imaging Range of Motion Articular Hamate Bone Fractures Comminuted Wound Healing medicine.diagnostic_test business.industry Angiography Digital Subtraction Digital subtraction angiography Anatomy Middle Aged Arthroplasty Treatment Outcome medicine.anatomical_structure Orthopedic surgery Upper limb Female Surgery Tomography X-Ray Computed Interphalangeal Joint business Follow-Up Studies |
| Zdroj: | Surgical and Radiologic Anatomy. 35:595-608 |
| ISSN: | 1279-8517 0930-1038 |
| DOI: | 10.1007/s00276-012-1072-2 |
| Popis: | The free vascularised hemi-hamate flap combines the utility of providing a small osteochondral portion of hamate for reconstruction, while providing a means of vascularisation to preserve articular cartilage after transfer. In Part 1 of this series, we highlighted the vascular approaches to such a technique. The current study investigates the bony architecture of the hamate, with particular emphasis on its utility for a range of osteochondral defects in the hand. A morphometric assessment of the hamate as a potential osteochondral flap donor site for resurfacing digital phalangeal heads (either total or unicondylar) and/or bases was thus undertaken. This anatomic study was undertaken using in vivo imaging performed for a range of clinical indications, with computed tomographic angiography (CTA) and digital subtraction angiography (DSA) of the upper limb included. Bony and vascular measurements and relationships were recorded and assessed both quantitatively and qualitatively. A clinical case is presented, highlighting the application of these measurements. The mean digital artery diameter was 0.7 mm with a mean distance between digital artery and interphalangeal joint surface (i.e. pedicle length) of 1.18 mm. Mean hamate dimensions comprised a transverse width 16.62 mm, lateral width of 14.29 mm and ridge height of 1.43 mm. Measurements of the phalangeal bases, condyles and total phalangeal heads were recorded, and the optimal hamate harvest approaches demonstrated. Despite perceived differences, in all cases there was statistical similarity demonstrated between the fragments. The hemi-hamate osteochondral flap can be applied to a range of osteochondral defects in the hand and may offer new options to the hand surgeon. |
| Databáze: | OpenAIRE |
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