Vascularized thumb metacarpal periosteal pedicled flap for scaphoid nonunion: An anatomical study and pediatric case report
Purpose Through an anatomical review, the primary aim of this study was to delineate the dorsal thumb metacarpal (TM) periosteal branches of the radial artery (RA). In addition, we report here the clinical utility of a vascularized TM periosteal pedicled flap (VTMPF), supplied by the first dorsal me...
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Published in | Microsurgery Vol. 39; no. 1; pp. 62 - 69 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
United States
Wiley Subscription Services, Inc
01.01.2019
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Subjects | |
Online Access | Get full text |
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Summary: | Purpose
Through an anatomical review, the primary aim of this study was to delineate the dorsal thumb metacarpal (TM) periosteal branches of the radial artery (RA). In addition, we report here the clinical utility of a vascularized TM periosteal pedicled flap (VTMPF), supplied by the first dorsal metacarpal artery (FDMA), in a complex case of scaphoid nonunion.
Methods
Ten latex‐colored upper limbs from fresh human cadavers were used. Branches of the RA were dissected under 3x loupe magnification, noting the periosteal branches arising from the FDMA. The VTMPF was measured for both length (cm) and width (cm).
Results
The FDMA provided a mean 12 periosteal branches (range 9 to 15), with a mean distance between branches of 0.5 cm (range 0.2–1.1), allowing for the design of a VTMPF which measured a mean 4 cm in length and 1.2 cm in width. We used a VTMPF to treat recalcitrant scaphoid nonunion, with a volar defect of 0.7 cm, in a 16‐year‐old boy. No bone graft was used. The patient experienced no postoperative complications. Successful consolidation was achieved three months after surgery, confirming the flap's survival. At 14‐months of postoperative follow‐up, the patient's VAS pain rating was 0 out of 100, and his DASH questionnaire score was 5. The patient had painless range that was 95% that of the contralateral limb. The patient's pinch and grip strengths were 6.5 kg and 28 kg, respectively (95% of unaffected side).
Conclusions
VTMPF may be considered a valuable and reliable surgical option for scaphoid nonunion in complex clinical scenarios. |
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Bibliography: | Funding information This research received no specific grants from any funding agency in the public, commercial, or not‐for‐profit sectors. To whom it may concern: we, the authors of this article, hereby state that no part of the work has either been submitted for publication or published elsewhere. We also state that the content of this article has been reviewed and approved by all the authors, in full belief that it has been written honestly and without plagiarism. Vascularized Thumb Metacarpal Periosteal Pedicled Flap for Scaphoid Nonunion: An Anatomical Study and Pediatric Case Report. Confidentiality: The authors declare that patient confidentiality was maintained throughout the duration of this study and afterwards. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0738-1085 1098-2752 |
DOI: | 10.1002/micr.30233 |