Background: Vascularized bone grafts of the hand are a promising option for treatment of hand abnormalities. Therefore, the purpose of this study was to analyze the arterial anatomy of the dorsal aspect of the second metacarpal base to further investigate this possible donor site for bone grafts.
Methods: The authors examined 16 fresh frozen cadaveric hands by using a C-arm cone beam computed tomography scanner and depicted the three-dimensional course of the second dorsal metacarpal artery and measured the diameter, length, and arc of rotation of this nutritive vessel. In addition, the authors dissected six of the hands under a dissecting microscope and, after selective injection of gelatin dye solution, the authors analyzed the vessel entrances into the bones histologically.
Results: In all examined hands, the second dorsal metacarpal artery was a nutritive vessel to the dorsal base of the second metacarpal. The average diameter was 1.3 ± 0.4 mm and the average length of the vascular pedicle was approximately 3.3 ± 0.3 cm. In 14 of 16 cases, the arc of rotation was sufficient to reach the lunate without difficulty. Histologic analysis showed an intrinsic blood supply in the donor region with a vessel diameter of approximately 58 μm. A clinical case with application in Kienböck disease is presented.
Conclusion: Pedicled vascularized bone grafts from this area are suitable for clinical application to treat Kienböck disease if standard donor sites are unavailable.
Erlangen, Ludwigshafen, and Heidelberg, Germany; and Vienna, Austria
From the Departments of Plastic and Hand Surgery, Neuroradiology, and Otorhinolaryngology–Head and Neck Surgery, University Hospital, Friedrich-Alexander-University of Erlangen-Nuremberg; Plastic and Reconstructive Surgery, Medical Institution Rudolfstiftung; Institute of Anatomy, University of Erlangen-Nuremberg; Department of Hand, Plastic, and Reconstructive Surgery–Burn Center, BG Trauma Center Ludwigshafen; and Department of Plastic Surgery, University of Heidelberg.
Received for publication October 21, 2013; accepted January 15, 2014.
The first two authors contributed equally to this article.
Disclosure: The authors have no commercial associations or financial disclosures to declare and there is no conflict of interest with information presented in this article.
Ali A. Saalabian, M.D., Plastic and Reconstructive Surgery, Medical Institution Rudolfstiftung, 25 Juchgasse, Vienna 1030, Austria, firstname.lastname@example.org