Vascularised bone graft, Mathoulin-Kuhlmann and Zaidemberg

1. Palmar pedicled vascularized bone flap of the radius (Kuhlmann/Mathoulin) 5th Workshop on Hand Flaps 04. - 05.02.2009 Dr. I. Tami Division of Plastic Surgery and Hand Surgery, University Hospital Zürich

4. Introduction 5th Workshop on Hand Flaps

5. Histor y 1965 palmar tubercle of scaphoid 1983 palmar distal radius 1987 free iliac crest 1991 dorsal distal radius 2000 free medial femoral condyle 2003 second metacarpal base 5th Workshop on Hand Flaps

6. Histor y 1965 palmar tubercle of scaphoid 1983 palmar distal radius 1987 free iliac crest 1991 dorsal distal radius 2000 free medial femoral condyle 2003 second metacarpal base 5th Workshop on Hand Flaps Kuhlmann J.N., Minoun M., Boabighi A., Baux S. Vascularised bone graft pedicled on the volar carpal artery for non-union of the scaphoid. J Hand Surg (Br) 1987; 12-B(2): 203-210.

7. Histor y 1965 palmar tubercle of scaphoid 1983 palmar distal radius 1987 free iliac crest 1991 dorsal distal radius 2000 free medial femoral condyle 2003 second metacarpal base 5th Workshop on Hand Flaps Mathoulin C., Haerle M. Vascularised bone graft from the palmar carpal artery for treatement of scaphoid nonunion. J Hand Surg (Br) 1998; 23-B(3): 318-323. « HARVESTING THE VASCULARIZED BONE GRAFT WAS A RELATIVELY DIFFICULT AND DELICATE PROCEDURE IN ALL CASES. »

8. Histor y 1965 palmar tubercle of scaphoid 1983 palmar distal radius 1987 free iliac crest 1991 dorsal distal radius 2000 free medial femoral condyle 2003 second metacarpal base 5th Workshop on Hand Flaps Fairbank S., Papadogeorgou E., Mathoulin C. Indications and outcomes of volar vascularised bone grafts for scaphoid nonunion. FESSH, Poznan (Pl), 3-6 June 2009.

9. Anatom y 5th Workshop on Hand Flaps Scaphoid Palmar Carpal Artery Radius Radial Artery Ulna Radius Scaphoid Palmar Carpal Artery Ulnar Artery Radial Artery M. Pronator Quadratus DRUJ

10. Technique Palmar Carpal Artery 5th Workshop on Hand Flaps

11. Technique 5th Workshop on Hand Flaps

12. Technique 5th Workshop on Hand Flaps FCR Radial Artery Palmar Carpal Artery

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14. Technique 5th Workshop on Hand Flaps

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18. Technique 5th Workshop on Hand Flaps 1 month 2 months 3 1/2 months

19. Dorso-radial pedicled vascularized bone flap of the radius (Zaidemberg) 5th Workshop on Hand Flaps 04. - 05.02.2009 Dr. I. Tami Division of Plastic Surgery and Hand Surgery, University Hospital Zürich

20. Histor y 1965 palmar tubercle of scaphoid 1983 palmar distal radius 1987 free iliac crest 1991 dorsal distal radius 2000 free medial femoral condyle 2003 second metacarpal base 5th Workshop on HandFlaps

21. Histor y 1965 palmar tubercle of scaphoid 1983 palmar distal radius 1987 free iliac crest 1991 dorsal distal radius 2000 free medial femoral condyle 2003 second metacarpal base 5th Workshop on HandFlaps Zaidemberg C., Siebert J.W., Angrigiani C. A new vascularized bone graft for scaphoid nonunion. J Hand Surg (Am) 1991; 16: 474-478.

22. Anatom y 1,2 I nter C ompartmental S upra R etinacular A rtery [email_address] 5th Workshop on HandFlaps

23. Anatom y Hand and wrist surgery, 2008 5th Workshop on HandFlaps

24. Technique [email_address] 5th Workshop on HandFlaps

25. Technique [email_address] 5th Workshop on HandFlaps

26. Technique 5th Workshop on HandFlaps

27. Technique Hand and wrist surgery, 2008 5th Workshop on HandFlaps

28. Technique [email_address] [email_address] 5th Workshop on HandFlaps

29. Technique 5th Workshop on HandFlaps

30. Technique 5th Workshop on HandFlaps

31. Technique [email_address] 5th Workshop on HandFlaps

33. Take care… … not to denude the vessels of the pedicle: preserve surrounding soft tissue to keep venous drainage … not to detach the periosteum from the bone … carefully close the extrinsic anterior carpal ligaments to prevent instability ( Kuhlmann/Mathoulin ) 5th Workshop on Hand Flaps

34. Thank you for your attention! … any questions? 5th Workshop on Hand Flaps