Original Communications
Experimental carpal reverse-flow pedicle vascularized bone grafts. Part II: Bone blood flow measurement by radioactive-labeled microspheres in a canine model*,**,*,**,,♢♢,

https://doi.org/10.1053/jhsu.2000.jhsu025a0046Get rights and content

Abstract

Reverse-flow pedicle vascularized bone grafts (VBGs) from the radius, commonly used for carpal nonunion and avascular necrosis, provide superior clinical results. In this experimental study bone blood flow in canine distal radius VBGs was measured to determine the status of the bone circulation immediately after elevation (group 1) and 2 weeks later (group 2). Immediate VBG flow (group 1) was substantial, but significantly less than the contralateral undisturbed distal radius (8.42 mL/min/100 g and 16.53 mL/min/100 g, respectively). At 2 weeks after surgery (group 2) VBG flow was compared with nonvascularized control grafts. Vascularized bone graft flow was significantly higher than group 1 (mean, 33.72 mL/min/100 g). Minimal flow was seen in the conventional graft control (0.62 mL/min/100 g). This study demonstrates that reverse-flow pedicle radius VBG maintain enhanced bone circulation long-term. Given the similarity of human and canine distal radius vascular anatomy, these data support the clinical use of reverse-flow VBG for carpal pathology. (J Hand Surg 2000;25A:46–54. Copyright © 2000 by the American Society for Surgery of the Hand.)

Section snippets

Preparation of animals

Sixteen adult mongrel dogs of either sex (weight, 22.5–30.0 kg) were divided into 2 groups of 8 each. X-rays demonstrated closure of the distal radius epiphysis. Blood flow was measured before and immediately after elevation of pedicle grafts in group 1. The other 8 dogs (group 2) were studied following a 2-week survival period by measuring and comparing the bone blood flow of isolated conventional and vascularized pedicle distal radius bones. Throughout the investigation, all animals were

Results

Elevation of the VBGs from the distal radius was successful in all 16 dogs, as demonstrated by pulsation of the vascular pedicle and bleeding from the bone graft. The average interval between induction of anesthesia and first microsphere injection was 108 minutes in group 1 and 95 minutes in group 2. The time used for each bolus microsphere injection ranged from 41 to 57 seconds (mean, 48.5 seconds). The measurement of right to left coefficient of variation allows quantitation of error for any

Discussion

Avascular necrosis of the lunate (Kienböck's disease)31, 32, 33, 34 and scaphoid, either spontaneous (Preiser's disease) or associated with fracture or nonunion, are difficult challenges for hand surgeons.35, 36, 37, 38, 39 Clinical solutions to these problems include efforts to prevent bony collapse by altering the biomechanics of wrist and direct revascularization of ischemic bone.28, 31, 40 The latter may be achieved with VBGs. They also may allow superior rates of bone healing and improved

References (45)

  • MG Rock et al.

    Radial shortening osteotomy for treatment of Kienböck's disease

    J Hand Surg

    (1991)
  • E Carpentier et al.

    Scaphoid nonunion: treatment by open reduction, bone graft, and staple fixation

    J Hand Surg

    (1995)
  • WP Cooney et al.

    Scaphoid nonunion: role of anterior interpositional bone grafts

    J Hand Surg

    (1988)
  • PK Davis et al.

    A torsional strength comparison of vascularized and nonvascularized bone grafts

    J Biomech

    (1982)
  • JN Kuhlmann et al.

    Vascularized bone graft pedicled on the volar carpal artery for non-union of the scaphoid

    J Hand Surg

    (1987)
  • MJ. Timmons

    William Harvey revisited: reverse flow through the valves of forearm veins

    Lancet

    (1984)
  • P Brüser et al.

    Die Transposition des gesteilten Os pisiforme zur Behandlung der Lunatum-Malazie. Stadium III

    Handchirurgie

    (1986)
  • G Pierer et al.

    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

    (1992)
  • C Fontaine et al.

    Anatomic basis of pronator quadratus flap

    Surg Radiol Anat

    (1992)
  • H Kawai et al.

    Pronator quadratus pedicled bone graft for old scaphoid fractures

    J Bone Joint Surg

    (1988)
  • JC Guimberteau et al.

    Recalcitrant non-union of the scaphoid treated with a vascularized bone graft based on the ulnar artery

    J Bone Joint Surg

    (1990)
  • S Pechlaner et al.

    Alternative Operation-smethode bei Kahnbeinpseudarthrosen: Prospektive Studie

    Handchirurgie

    (1987)
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    *

    *Present address: Department of Orthopedics, Chang Gung Memorial Hospital, Keelung, Taiwan.

    **

    Present address: Department of Orthopedics, Kumamoto University, Kumamoto, Japan.

    *

    Supported in part by research grant AR-38671 from the National Institutes of Health.

    **

    No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

    Reprint requests: Allen T. Bishop, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

    ♢♢

    0363-5023/00/25A01-0011$3.00/0

    J Hand Surg 2000;25A:46–54.

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