Does Anyone Need a Vascularized Graft? - 08/06/19

Doi : 10.1016/j.hcl.2019.03.005

Schneider K. Rancy, BA ^a, Gernot Schmidle, MD ^b, Scott W. Wolfe, MD ^c,^⁎
^a College of Medicine, SUNY Downstate Medical Center, 1160 Ocean Avenue, Apt 5F, Brooklyn, NY 11230, USA
^b Department of Trauma Surgery, Medical University Innsbruck, Anichstraße 35, Innsbruck 6020, Austria
^c Hand and Upper Extremity Service, Hospital for Special Surgery, Weill Medical College of Cornell University, 535 East 70th Street, New York, NY 10021, USA

^∗Corresponding author.

Resumen

Many hand surgeons argue that vascularized bone grafting is indicated in proximal pole avascular necrosis, prior failed surgery, or long-standing scaphoid nonunion. However, the available evidence does not support improved treatment outcomes for vascularized bone grafting rather than traditional nonvascularized techniques. This article addresses the available evidence and examines the role of vascularized bone grafting in scaphoid nonunion treatment. It also identifies important factors that influence healing, clarifies the decision-making algorithm, and proposes areas for further research.

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Keywords : Scaphoid nonunion, Vascularity, Avascular necrosis, Ischemia, Infarction, Vascularized bone graft, Nonvascularized bone graft, Creeping substitution