The vascular basis of the hemi-hamate osteochondral free flap. Part 1: Vascular anatomy and clinical correlation

Warren Rozen, Vachara Niumsawatt, Richard Ross, James Chin Sek Leong, Edmund Ek

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.
Original languageEnglish
Pages (from-to)585 - 594
Number of pages10
JournalSurgical and Radiologic Anatomy: journal of clinical anatomy
Volume35
Issue number7
DOIs
Publication statusPublished - 2013

Cite this

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title = "The vascular basis of the hemi-hamate osteochondral free flap. Part 1: Vascular anatomy and clinical correlation",
abstract = "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.",
author = "Warren Rozen and Vachara Niumsawatt and Richard Ross and Leong, {James Chin Sek} and Edmund Ek",
year = "2013",
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volume = "35",
pages = "585 -- 594",
journal = "Surgical and Radiologic Anatomy: journal of clinical anatomy",
issn = "0930-312X",
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}

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 journalArticleResearchpeer-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 -