A different option in vascular bone grafts in the hand and wrist region: Use of a dorsoulnar artery-based osteo-fascio-cutaneous flap: A case series
Osman Orman1
, Fikret Eren2, Ahmet Duran Kara3, Ceyhun Cesur4, Cengiz Yıldırım5, Bilge Kağan Aysal6
1Department of Hand Surgery, Istanbul Metin Sabancı Baltalimanı Bone Diseases Training and Research Hospital, Istanbul, Turkey
2Plastic and Reconstructive Surgery, Private Practice, Antalya, Turkey
3Department of Orthopedics and Traumatology, Rumeli University, Reyap Hospital, İstanbul, Turkey
4Department of Plastic and Reconstructive Surgery, Bodrum State Hospital of the Ministry of Health, Muğla, Turkey
5Department of Orthopedics and Traumatology, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
6Department of Plastic and Reconstructive Surgery, Muğla Sıtkı Koçman University, Muğla, Turkey
Keywords: Bone reconstruction, Kienböck’s disease, scaphoid nonunion, vascularized bone graft
Abstract
Objectives: This study aims to describe our surgery technique and discuss patients treated through the dorsoulnar artery (DUA)-based technique of osseous and osteo-fascio-cutaneous vascularized ulnar bone grafting.
Patients and methods: Between January 2011 and January 2015, six male patients (median age: 22.5 years; range, 20 to 24 years) who underwent surgery during which the technique of DUA ulnar bone graft was utilized. One patient with scaphoid nonunion, three patients with Kienböck’s disease, and two patients with a traumatic metacarpal defect were retrospectively evaluated. The joint range of motion (ROM), grip strength, Disabilities of the arm, shoulder and Hand (DASH) questionnaire score and Visual Analog Scale (VAS) score, and radiographies before and after surgery were examined. Scintigraphy was performed at 12 weeks postoperatively to monitor the viability of the bone graft.
Results: All patients showed improvements in the ROM, grip strength, VAS, and DASH scores. According to the radiographic examination, bone union was achieved in all patients and the scintigraphy revealed that vascularization was detected in the bone tissue.
Conclusion: The advantages of DUA-based vascularized bone graft are good bone quality and quantity and versatility due to its long pedicle. The osteo-fasio-cutaneous DUA flap seems to be effective in the treatment of traumatic metacarpal bone defects accompanied by skin loss. The DUA-based vascularized ulnar bone may be a source for scaphoid and lunate biological bone reconstruction.
Citation: Orman O, Eren F, Kara AD, Cesur C, Yıldırım C, Aysal BK. A different option in vascular bone grafts in the hand and wrist region: Use of a dorsoulnar artery-based osteo-fascio-cutaneous flap: A case series. Jt Dis Relat Surg 2021;32(2):504-513.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
Special thanks to Hüseyin Karagöz for sharing cadaveric dissection figures.