Purpose
Autologous bone grafting is commonly used in reconstructive hand surgery. Various
sources of nonvascularized autologous bone grafts have been described in the literature.
However, in some situations, a vascularized bone graft may be needed. Popular vascularized
bone grafts are taken from the distal radius, iliac crest, and medial femoral condyle.
The purpose of this study was to examine the feasibility of harvesting a free vascularized
bone flap from the proximal ulna.
Methods
Latex was injected via the brachial artery to facilitate visualization of perforators
in 10 cadaveric specimens. Dissections were performed of the olecranon; all periosteal
perforators were noted, and their lengths and diameters recorded. Corticocancellous
bone flaps with their supplying pedicles were harvested. Three additional fresh specimens
were injected with india ink via the pedicles to demonstrate perfusion of the harvested
bone flap.
Results
Consistent vascular anatomy supplied the olecranon. A perforator from the posterior
ulnar recurrent artery supplied the proximal ulna and olecranon, from which a vascularized
bone flap can be harvested. Branches to the flexor carpi ulnaris muscle may allow
chimeric flaps to be harvested. Average pedicle length was 5.8 cm and average pedicle
diameter was 2.4 mm. India ink injection of the pedicles showed perfusion of the periosteum
as well as intraosseous cancellous bone.
Conclusions
A vascularized olecranon free flap can be harvested based on the posterior ulnar recurrent
artery. Vascular anatomy is consistent and flap harvest is simple and straightforward
in all cadaveric specimens.
Clinical relevance
A vascularized olecranon free flap represents a potential new surgical option when
vascular bone flap reconstruction is considered.
Key words
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Article info
Publication history
Published online: July 11, 2019
Accepted:
May 10,
2019
Received:
October 16,
2018
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
