Abstract
Well-known advantages of vascularized bone grafts led us to determine the anatomical basis of a metacarpal vascularized bone graft to find a solution for distal index bone loss. Seventeen adult human hands from fresh cadavers were dissected and analyzed. For each hand, we studied the second dorsal metacarpal artery, the ulnar dorsal proper digital artery of index, and the ulnar palmar proper digital artery of the index. Location, diameters, origins, and anastomoses were observed, and at the end, the vascularised bone graft was raised. The second dorsal metacarpal artery was present in all hands, always arising from the dorsal carpal arch with a 1-mm mean diameter. The ulnar dorsal proper digital artery of index was isolated on all dissections, with a subcutaneous location on the ulno-dorsal side of the proximal phalanx. The mean diameter of ulnar dorsal proper digital artery at the level of index proximal phalanx was 0.4 mm. We found anastomotic branches between the ulnar dorsal and palmar proper digital artery of index at the level of the proximal phalanx which permitted us to elevate a vascularised bone graft. We succeeded in removing the graft in all specimens. Its pivot point was always more distal than the middle of the proximal phalanx. The arc of rotation allowed the graft to reach the distal phalanx in 80% of the cases. This anatomical study has demonstrated the theoretical possibility of a reversed pedicled bone graft taken from the ulnar neck of the second metacarpal. This graft brings the following benefits: (a) the use of a minor vascular axis, (b) a surgical technique with a dorsal approach allowing the elevation and the use of the graft at the same time. It can be used on the index for failures of DIP joint arthrodesis, huge chondroma, or traumatology.
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References
Beldame J, Havet E, Auquit-Auckbur I, Lefebvre B, Mure JP, Duparc F (2008) Arterial anatomical basis of the dorsal digito-metacarpal flap for long fingers. Surg Radiol Anat 30(5):429–435
Brunelli F, Brunelli G Jr, Nanfito F (1991) An anatomical study of the vascularisation of the first dorsal interosseous space in the hand, and a description of a bony pedicle graft arising from the second metacarpal bone. Surg Radiol Anat 13:73–75
Brunelli F, Mathoulin C, Saffar P (1992) Description d’un greffon osseux vascularisé prélevé au niveau de la tête du deuxième métacarpien. Ann Chir Main 11:40–45
Brunelli F, Vigasio A, Valenti P, Brunelli GR (1999) Arterial anatomy and clinical application of the dorsoulnar flap of the thumb. J Hand Surg Am 24(4):803–811
Brunelli F, Gilbert A (2001) Vascularization of the thumb. Anatomy and surgical applications. Hand Clin 17(1):123–138
Bertelli JA, Pagliei A, Lassau JP (1992) Role of the first dorsal metacarpal artery in the construction of pedicled bone grafts. Surg Radiol Anat 14:275–277
Dautel G, Merle M (1992) Direct and reverse dorsal metacarpal flaps. Br J Plastic Surg 45:123–130
Dubert T, Houimli S, Valenti P, Dinh A (1997) Very distal finger amputations: replantation or “reposition-flap” repair? J Hand Surg Br 22(3):353–358
Earley J (1986) The arterial supply of the thumb, first web and index finger and its surgical application. J Hand Surg 11B:163–174
Foucher G, Braga Da Silva J, Boulas J (1992) “Reposition-flap” technique in amputation of the finger tip. A propos of a series of 21 cases. Ann Chir Plast Esthet 37(4):438–442
Gosain K, McCarthy JG, Staffenberg D, Glat PM, Simmons DJ (1996) The histomorphologic changes in vascularized bone transfers and their interrelationship with the recipient sites: A 1-year study. Plast Reconstr Surg 96:1001–1013
Green DP (1985) The effect of avascular necrosis on Russe bone grafting for scaphoid nonunion. J Hand Surg Am 10:597–605
Kakinoki R, Ikeguchi R, Matsumoto T et al (2008) Reconstruction of a phalangeal bone using a vascularised metacarpal bone graft nourished by a dorsal metacarpal artery. Injury 39(Suppl 4):25–28
Khan K, Riaz M, Small JO (1998) The use of the second dorsal metacarpal artery for vascularized bone graft An anatomical study. J Hand Surg Br 23(3):308–310
Makino M (2000) Vascularized metacarpal bone graft for scaphoid non-union and Kienbock’s disease. J Reconstr Microsurg 16(4):261–268
Pierer G, Steffen J, Hoflehner H (1992) The vascular blood supply of the second metacarpal bone: anatomic basis for a new vascularized bone graft in hand surgery. An anatomical study in cadavers. Surg Radiol Anat 14(2):103–112
Pistre V, Pelissier P, Martin D, Baudet J (2001) Vascular blood supply of the dorsal side of the thumb, first web and index finger: anatomical study. J Hand Surg Br 26(2):1–98
Pistre V, Reau AF, Pelissier P, Martin D, Baudet J (2001) Vascularized bone pedicle grafts of the hand and wrist: literature review and new donor sites. Chir Main 20(4):263–271
Strauch B, de Moura W (1990) Arterial system of the fingers. J Hand Surg Am 15(1):148–154
Yuceturk A, Isikar ZU, Tuncay C, Tandogan R (1997) Treatment of scaphoid nonunions with a vascularized bone graft based on the first dorsal metacarpal artery. J Hand Surg 22B:425–427
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We thank Jean Marc Elissalde for his technical assistance.
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Ardouin, L., Le Nen, D., Geffard, B. et al. Anatomic basis of ulnar index metacarpal reverse flow vascularized bone graft for index distal bone loss. Surg Radiol Anat 32, 719–723 (2010). https://doi.org/10.1007/s00276-010-0676-7
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DOI: https://doi.org/10.1007/s00276-010-0676-7