Vascularized rib graft for proximal scaphoid reconstruction: An anatomical study

IF 1 4区医学 Q4 ORTHOPEDICS

Hand Surgery & Rehabilitation Pub Date : 2025-09-01 DOI:10.1016/j.hansur.2025.102214

Yaniv Bismuth , Charlotte Jaloux , Julien Gaillard , Alain Sautet , Adeline Cambon , Claire Bastard

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引用次数: 0

Abstract

The loss of cartilaginous substance at the proximal pole of the scaphoid bone poses a therapeutic challenge, with 10% of fractures in this area progressing to pseudarthrosis and necrosis of the proximal pole. Our aim is to propose a conservative surgical alternative involving replacing the necrotic scaphoid with a vascularized osteochondral graft taken from the fourth rib. Angiography of the donor site was performed on seven hemithoraxes to analyze the osteochondral vascularization. Twenty vascularized osteochondral grafts were then performed on anatomical subjects after the proximal pole of the scaphoid was excised. The osteochondral vascularization of the donor site remained consistent, with the presence of a posterior intercostal collateral artery at each level. The harvested grafts averaged 3.1 cm in length and 1.2 cm in thickness. The average arterial diameter was 2.5 mm, the venous diameter was 3 mm, and the average pedicle length was 2.9 cm. We present a reliable and reproducible technique that offers satisfactory anatomical reconstruction.

Level of evidence

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带血管肋移植重建舟状骨近端：解剖学研究。

舟状骨近端软骨物质的缺失对治疗提出了挑战，该区域10%的骨折进展为假关节和近端坏死。我们的目的是提出一种保守的手术替代方案，包括用取自第四肋骨的带血管的骨软骨移植物代替坏死的舟状骨。对7个半胸供体部位进行血管造影，分析骨软骨血管化情况。在切除舟状骨近端后，在解剖对象上进行了20例带血管的骨软骨移植。供体部位的骨软骨血管化保持一致，在每个水平上都存在后肋间侧支动脉。收获的移植物平均长3.1 cm，厚1.2 cm。平均动脉直径2.5 mm，静脉直径3 mm，平均蒂长2.9 cm。我们提出了一个可靠的和可重复的技术，提供满意的解剖重建。证据水平：

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来源期刊

Hand Surgery & Rehabilitation Medicine-Surgery

CiteScore

1.70

自引率

27.30%

发文量

审稿时长

49 days

期刊介绍： As the official publication of the French, Belgian and Swiss Societies for Surgery of the Hand, as well as of the French Society of Rehabilitation of the Hand & Upper Limb, ''Hand Surgery and Rehabilitation'' - formerly named "Chirurgie de la Main" - publishes original articles, literature reviews, technical notes, and clinical cases. It is indexed in the main international databases (including Medline). Initially a platform for French-speaking hand surgeons, the journal will now publish its articles in English to disseminate its author''s scientific findings more widely. The journal also includes a biannual supplement in French, the monograph of the French Society for Surgery of the Hand, where comprehensive reviews in the fields of hand, peripheral nerve and upper limb surgery are presented. Organe officiel de la Société française de chirurgie de la main, de la Société française de Rééducation de la main (SFRM-GEMMSOR), de la Société suisse de chirurgie de la main et du Belgian Hand Group, indexée dans les grandes bases de données internationales (Medline, Embase, Pascal, Scopus), Hand Surgery and Rehabilitation - anciennement titrée Chirurgie de la main - publie des articles originaux, des revues de la littérature, des notes techniques, des cas clinique. Initialement plateforme d''expression francophone de la spécialité, la revue s''oriente désormais vers l''anglais pour devenir une référence scientifique et de formation de la spécialité en France et en Europe. Avec 6 publications en anglais par an, la revue comprend également un supplément biannuel, la monographie du GEM, où sont présentées en français, des mises au point complètes dans les domaines de la chirurgie de la main, des nerfs périphériques et du membre supérieur.