Vascularized Bone Graft Based on the Volar Carpal Artery for the Treatment of Scaphoid Pseudoarthrosis

Introduction: The grafting technique we report is based on the volar carpal artery which exists between radial and ulnar artery and communicate with anterior interosseus artery.

We report the results of anatomical study and clinical application of vascularized bone graft based on the volar carpal artery for the treatment of scaphoid pseudoarthrosis.

Methodology and Material: Operative procedure was mainly based on the technique described by Mathoulin et al.

But the technique of fixating the bone in the fracture site is a little different.

After careful curettage of fracture site, we performed reduction　of the scaphoid and fixate the bone with two k-wires. Through the aponeurosis, volar carpal artery could be found and also be seen running toward the volar and ulnar side of the radius on the periosteum. Bone graft is taken from the ulnar and volar side of the radius according to the size of the bone defect of the scaphoid. The pedicle was dissected as much as possible to get the enough arch for transferring the bone.

Results: -Anatomical study-

In all cadaver hands, origin of the volar carpal artery was identified. In seven out of eight hands, the existence of the volar carpal artery on the radius was identified.

-Clinical cases-

In all clinical cases, bleeding from the bone approved its vascularization.

We conclude that existence of volar carpal artery in Japanese hands is certain with both anatomical and clinical results.

In all 7 cases bone union was obtained. Bone union was obtained 6-11 weeks after operation (on average 7.3 weeks). Cases are presented in Fig. 5-6. In all cases pain relief were obtained. Details are shown in Table 1. According to Cooney’s evaluation, 5 cases were classified as an excellent and two as a good.

Conclusions: We used this technique for the treatment of scaphoid pseudoarthrosis with minimum bone loss and without radioscaphoid arthritis. We usually use the bone graft from the palmar aspect of the radius (non-vascularized). We think that vascularized bone has much potential than non-vascularized bone for bone union. This procedure can add the vascularization for conventional bone graft from the radius. Early bone union of this series show the potential of this procedure with high reliability of the pedicle and can be performed with one skin incision, can be done in one tourniquet time and outpatients method is possible.