Abstract
| Original language | English |
|---|---|
| Pages (from-to) | 585 - 594 |
| Number of pages | 10 |
| Journal | Surgical and Radiologic Anatomy: journal of clinical anatomy |
| Volume | 35 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 2013 |
Cite this
}
The vascular basis of the hemi-hamate osteochondral free flap. Part 1: Vascular anatomy and clinical correlation. / Rozen, Warren; Niumsawatt, Vachara; Ross, Richard; Leong, James Chin Sek; Ek, Edmund.
In: Surgical and Radiologic Anatomy: journal of clinical anatomy, Vol. 35, No. 7, 2013, p. 585 - 594.Research output: Contribution to journal › Article › Research › peer-review
TY - JOUR
T1 - The vascular basis of the hemi-hamate osteochondral free flap. Part 1: Vascular anatomy and clinical correlation
AU - Rozen, Warren
AU - Niumsawatt, Vachara
AU - Ross, Richard
AU - Leong, James Chin Sek
AU - Ek, Edmund
PY - 2013
Y1 - 2013
N2 - Purpose: The treatment of comminuted fractures of the proximal interphalangeal joint is highly challenging due to the complexities of joint bio-mechanics and stability. The hemi-hamate osteochondral auto-graft has been popularised in this role, able to replace articular loss and restore joint stability. Recent evaluation of their long-term follow-up however has shown the early development of osteoarthritis and potential early cartilage loss, which may be due to the non-vascularised nature of the graft. We offer a new technique that maintains vascularisation of the transferred hamate fragment, and investigate the anatomical vascular basis for the technique. Methods: Dissection and angiographic studies of ten cadaveric specimens were undertaken, exploring the vascular anatomy of the dorsal hamate. A clinical case of hemi-hamate osteochondral free flap is presented, including preoperative, intraoperative and postoperative investigation of the relevant vasculature. Results: Cadaveric studies demonstrated dorsal vascular supply to the hamate from the central of three dorsal carpal arches. The arch was supplied by the dorsal branch of the ulnar artery. Multiple supracapsular veins are present for use in flap venous drainage. This vascular pattern was found to be constant. A clinical case of hemi-hamate osteochondral free flap harvest demonstrated the same vascular anatomy intraoperatively. The digital artery was used as a recipient for microvascular anastomosis. Postoperative computed tomographic angiography and nuclear bone scan confirmed flap perfusion. Conclusions: The hemi-hamate osteochondral flap has a reliable anatomical vascular basis, and is clinically feasible as a technique for early vascularisation of the osteochondral fragment to sustain the transferred articular cartilage. ? 2013 Springer-Verlag France.
AB - Purpose: The treatment of comminuted fractures of the proximal interphalangeal joint is highly challenging due to the complexities of joint bio-mechanics and stability. The hemi-hamate osteochondral auto-graft has been popularised in this role, able to replace articular loss and restore joint stability. Recent evaluation of their long-term follow-up however has shown the early development of osteoarthritis and potential early cartilage loss, which may be due to the non-vascularised nature of the graft. We offer a new technique that maintains vascularisation of the transferred hamate fragment, and investigate the anatomical vascular basis for the technique. Methods: Dissection and angiographic studies of ten cadaveric specimens were undertaken, exploring the vascular anatomy of the dorsal hamate. A clinical case of hemi-hamate osteochondral free flap is presented, including preoperative, intraoperative and postoperative investigation of the relevant vasculature. Results: Cadaveric studies demonstrated dorsal vascular supply to the hamate from the central of three dorsal carpal arches. The arch was supplied by the dorsal branch of the ulnar artery. Multiple supracapsular veins are present for use in flap venous drainage. This vascular pattern was found to be constant. A clinical case of hemi-hamate osteochondral free flap harvest demonstrated the same vascular anatomy intraoperatively. The digital artery was used as a recipient for microvascular anastomosis. Postoperative computed tomographic angiography and nuclear bone scan confirmed flap perfusion. Conclusions: The hemi-hamate osteochondral flap has a reliable anatomical vascular basis, and is clinically feasible as a technique for early vascularisation of the osteochondral fragment to sustain the transferred articular cartilage. ? 2013 Springer-Verlag France.
UR - http://www.ncbi.nlm.nih.gov/pubmed/23508930
U2 - 10.1007/s00276-013-1098-0
DO - 10.1007/s00276-013-1098-0
M3 - Article
VL - 35
SP - 585
EP - 594
JO - Surgical and Radiologic Anatomy: journal of clinical anatomy
JF - Surgical and Radiologic Anatomy: journal of clinical anatomy
SN - 0930-312X
IS - 7
ER -