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Revascularization Procedures forKienböckDisease

Kakar, Sanjeev MD, MRCS, MBA; Giuffre, Jennifer L. MD; Shin, Alexander Y. MD

Techniques in Hand & Upper Extremity Surgery: March 2011 - Volume 15 - Issue 1 - p 55–65
doi: 10.1097/BTH.0b013e318206f428
Kienböck's Disease: The Past 100 Years and a Look at the Future, Edited by Dr. Gregory I. Bain: Techniques

The goals of treatment in Kienböck disease include preservation of wrist function, maintaining normal wrist kinematics, and revascularization of the necrotic lunate when and if possible. A variety of pedicled vascularized bone graft options exist and include but are not limited to pedicled grafts from the volar radius, dorsal radius, metacarpal heads or bases, and pisiform. Of the various treatment options, pedicled vascularized bone grafts from the dorsal distal radius based on the fourth and fifth extensor compartment arteries has been successful in the revascularization of the necrotic lunate at our institution. Vascularized bone grafting is an attractive alternative to conventional bone grafting by improving the local biological environment and thereby promoting revascularization. Recent advances in the anatomy and physiology of vascularized pedicled bone grafts have increased our ability to apply them to the treatment of Kienböck disease. The purpose of this article is to describe the various types of pedicled vascularized bone graft available, to detail the vascular anatomy of the dorsal distal radius, and to describe the surgical technique of our preferred vascularized bone graft (the fourth+fifth extensor compartment artery graft). In addition, the indications, contraindications, and outcomes are described.

Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN

Support: None.

Address correspondence and reprint requests to Alexander Y. Shin, MD, Department of Orthopaedic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905. e-mail:

Disclosure: None.

© 2011 Lippincott Williams & Wilkins, Inc.