Zaidenberg Ezequiel Ernesto, Martinez Ezequiel, Zaidenberg Carlos Rodolfo
Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina; Department of Orthopaedics, Italian Hospital of Buenos Aires, Buenos Aires, Argentina.
Anatomy Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina.
J Hand Surg Am. 2018 Jul;43(7):685.e1-685.e5. doi: 10.1016/j.jhsa.2018.03.005. Epub 2018 Apr 9.
Various methods have been reported to treat forearm nonunions with good results. However, in the presence of infection, inadequate vascularity of surrounding tissues, or failed prior grafts, vascularized bone grafts are a valid alternative. We describe the surgical technique to obtain distal radius vascularized bone graft pedicled on the radial artery (RA) and its clinical application in 1 case of an ulnar nonunion. We studied the surgical technique in 12 freshly injected cadavers. In the distal forearm, the RA provides several periosteal branches to supply the distal radius metaphysis. These vessels are located between the distal insertion of the brachioradialis and the deep surface of the radial half of the pronator quadratus. A 6-cm vascularized bone graft can be harvested from the radius, and dissection of the RA enables a long pedicle with a wide arc of rotation readily able to reach the proximal part of the ulna. The present technique is a reproducible alternative that allows the treatment of bone defects up to 6 cm, without the potential technical difficulties of a free bone flap.
据报道，有多种方法可用于治疗前臂骨不连，且效果良好。然而，在存在感染、周围组织血运不足或先前移植失败的情况下，带血管蒂骨移植是一种有效的选择。我们描述了一种以桡动脉（RA）为蒂获取桡骨远端带血管蒂骨移植的手术技术及其在1例尺骨骨不连中的临床应用。我们在12具新鲜注射的尸体上研究了该手术技术。在前臂远端，桡动脉发出数支骨膜支供应桡骨远端干骺端。这些血管位于肱桡肌远端止点与旋前方肌桡侧半深面之间。可从桡骨获取一段6厘米长的带血管蒂骨移植，解剖桡动脉可形成一个长蒂，其旋转弧宽，能够轻松到达尺骨近端。本技术是一种可重复的选择，可用于治疗长达6厘米的骨缺损，且不存在游离骨瓣可能出现的技术难题。
