Summary
After traumatic loss of the index finger the second metacarpal bone is often used as a free graft to reconstruct bony defects of the thumb. Since clinical experience has shown numerous advantages of using a blood supplied bone graft, an anatomical study was performed in 104 cadaveric hands to investigate the vascularization supply of this bone. After dye injections into the arterial system the vascular situation of the second metacarpal was studied and a classification was made. Six variations in arterial vascularization were found. The nutrient vessels to the bone originate from the radial artery or from the deep palmar arch and correspond to variable metacarpal arteries. Selective injection studies via the respective pedicles showed sufficient perfusion and complete dye distribution in the bone. Further dissections could demonstrate the feasibility of raising a pedicled bone graft only partially with preservation of the index finger. The second metacarpal as a vascularized graft may be harvested entirely in serious injuries with destruction of the index finger in emergency cases of skeletal thumb reconstruction or partially as an elective procedure. All type have a useful are of rotation and their pedicles allow transpositions within the radial side of the hand, especially for applications in the thumb and carpus. The clinical application of these procedures could be shown in five cases. The results of this study therefore provide the anatomical basis for transposition or free microvascular transplantation of the second metacarpal as a vascularized bone graft for a variety of indications in hand surgery.
Résumé
Après une perte de substance osseuse post traumatique du pouce associée à une perte de l'index, un greffon osseux vascularisé est souvent utilisé pour reconstruire le pouce à partir du deuxième métacarpien. Un transfer osseux présente des avantages quand il est vascularisé. Pour cette raison les auteurs ont étudié, sur 104 mains prelevées sur des cadavres, les bases anatomiques et les possibilités d'une transposition du métacarpe II avec un pédicule vasculaire. Après l'injection intraartérielle, la vascularisation du 2eme métacarpien II a été étudiée et une classification a été faite. Les auteurs ont trouvé six variantes différentes. Les artères nourricières proviennent de l'a. radiale ou de l'arcade palmaire profonde et forment les aa. métacarpiennes de situation variable. Des injections sélectives avec bleu de méthylène dans les artères ont prouvé les bonnes conditions de perfusion avec une diffusion du la substance colorante dans l'os entier. La longueur des pédicules vasculaires permet une rotation correcte de ce transfert osseux sur le versant radial de la main dans chaque variante, plus particulièrement dans le cas des applications au pouce et à la racine de main. Les résultats de ces recherches constituent la base anatomique pour une nouvelle méthode reconstructive dans la chirurgie de la main.
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References
Adachi B (1928) Das Arteriensystem der Japaner. Maruzen, Kyoto
Ariyan S, Finseth FJ (1978) The anterior chest approach for obtaining free osteocutaneous rib grafts. Plast Reconstr Surg 62: 676–685
Barth A (1893) Über histologische Befunde nach Knochenimplantation. Arch Klin Chir 46: 409
Barth A (1895) Histologische Untersuchungen über Knochentransplantation. Beitr Path Anat Allg Pathol 17: 65
Boyd JB, Manktelow RT (1988) Free vascularized bone grafts. In: Brunelli G (ed) Textbook of Microsurgery. Masson, Milano, pp 339–349
Braun RM (1983) Pronator pedicle bone grafting in the forearm and proximal carpal row. Proceedings Am Soc Surg Hand 8: 318–323
Buncke HJ, Furnas DW, Gordon L, Achauer BM (1977) Free osteocutaneous flap from a rib to the tibia. Plast Reconstr Surg 61: 494–506
Chacha PB (1984) Vascularized pedicular bone grafts. Int Orthop 8: 117–138
Cormack GC, Duncan MJ, Lamberty BGH (1986) The blood supply of the bone component of the compound osteocutaneous radial artery forearm flap: an anatomical study. Br J Plast Surg 39: 173–175
Cutting CB, McCarthy JG, Knize DM (1990) Repair and grafting of bone. In: McCarthy JG (ed) Plastic Surgery, WB Saunders, Philadelphia, pp 583–629
Deutinger M, Porenta G, Metz V, Kaliman J, Freilinger G (1989) Hämodynamische und klinische Untersuchungen nach Verletzung von Unterarmarterien. Handchir Mikrochir Plast Chir 21: 283–286
DOI K et al (1977) Bone grafts with microvascular anastomoses of vascular pedicles. Am J Bone Joint Surg 59: 809–815
Doi K, Hattori S, Kawai S, Nakamura S, Kotani H, Matsuoka A, Sunago K (1981) New procedure on making a thumb. One-stage reconstruction with free neuro-vascular flap and iliac bone graft. Hand Surg 6: 346–350
Earley MJ (1986) The arterial supply of the thumb, first web and index finger and its surgical application. Br J Hand Surg 11: 163–172
Earley MJ, Milner RH (1987) Dorsal metacarpal flaps. Br J Plast Surg 40: 333–341
Ebner I, Hammer H (1988) Aspekte der arteriellen Gefäßbeziehung im Hohlhandbereich. Acta Anat 131: 297–304
Foucher G, van Genechten F, Merle M, Michon J (1984) Single stage thumb reconstruction by a composite forearm island flap. Br J Hand Surg 9: 245–248
Gang RK, Makhlouf S (1986) One-stage reconstruction of the thumb using an osteo-cutaneous radial artery forearm flap. Eur J Plast Surg 9: 79–81
Gegenbauer C (1883) Lehrbuch der Anatomie des Menschen. Engelmann, Leipzig
Hafferl A, Thiel W (1969) Lehrbuch der topographischen Anatomie. Springer, Berlin Heidelberg New York
Henle J (1876) Handbuch der Gefäßlehre des Menschen. 2.Aufl. Vieweg Braunschweig
Hoflehner H, Pierer G, Steffen J (1991) Daumenskelettrekonstruktion durch vaskularisierte Metakarpale-II-Transposition. Anatomische Studie und klinische Fallbeispiele. Handchir Mikrochir Plast Chir 23: 82–89
Lanz T, Wachsmuth W (1959) Praktische Anatomie. Springer, Berlin
Maruyama Y (1990) The reverse dorsal metacarpal flap. Br J Plast Surg 43: 24–27
McKee DM (1978) Microvascular bone transplantation. Clin Plast Surg 5: 238–245
Meyer VE (1983) Freie Transplantation einer Fibula mit mikrovaskulären Anastomosen zur Überbrückung eines 9 cm langen Tibia-Defektes. Hand Chir 15: 64–68
Millesi H, Piza H (1978) Freie Transplantation einer Fibula mit Epiphyse. Hand Chir 10: 115–119
Moore JB, Mazur JM, Zehr D, Davis PK, Zook EG (1984) A biomechanical comparison of vascularized and conventional autogenous bone grafts. Plast Reconstr Surg 73: 382–386
Östrup LT, Fredrickson JM (1974) Distant transfer of a free, living bone graft by microvascular anastomoses. Plast Reconstr Surg 54: 274–285
Pechlaner S, Hussl H, Künzel KH (1987) Alternative Operationsmethode bei Kahnbeinpseudoarthrosen. Hand Chir 19: 302–305
Pierer G, Hoflehner H, Ehall R, Steffen J (1991) The metacarpal bone graft on a vascular pedicle — A new procedure for vital bone transposition. International Society of Reconstructive Microsurgery, Munich, 15–21 September
Pierer G, Hoflehner H, Steffen J (1991) Die gefäßgestielte Metacarpale-II-Transposition. Klinische Anwendungen. 32.Symposium der Deutschsprachigen Arbeitsgemeinschaft für Handchirurgie, Bern, 17–19 October
Quaba AA, Davison PM (1990) The distally-based dorsal hand flap. Br J Plast Surg 43: 28–39
Small JO, Brennen MD (1990) The second dorsal metacarpal artery neurovascular island flap. Br J Plast Surg 43: 17–23
Soutar DS, Scheker LR, Tanner NSB, McGregor IA (1983) The radial forearm flap: a versatile method for intraoral reconstruction. Br J Plast Surg 36: 1–8
Swartz WM, et al (1986) The osteocutaneous scapular flap for mandibular and maxillary reconstruction. Plast Reconstr Surg 77: 530–545
Tamai S (1988) Fibular microvascular graft. Clinical experiences and experimental study on rats. In: Brunelli G (ed) Textbook of Microsurgery. Masson, Milano, pp 351–359
Tamai S, et al (1972) Microvascular surgery in orthopedics and traumatology. Br J Bone Joint Surg 54: 637–645
Tandler J (1897) Zur Anatomie der Arterien der Hand. Anat Hft 7: 263–282
Taylor GI, Miller GDH, Ham FJ (1975) The free vascularized bone graft. A clinical extension of microvascular techniques. Plast Reconstr Surg 55: 533–545
Taylor GI, Townsend P, Corlett R (1979) Superiority of the deep circumflex iliac vessels as the supply for free groin flaps; experimental work. Plast Reconstr Surg 64: 595–604
Taylor GI, Townsend P, Corlett R (1979) Superiority of the deep circumflex iliac vessels as the supply for free groin flaps; clinical work. Plast Reconstr Surg 64: 745–759
Teot L, Bosse JP, Moufarrege R, Papillon J, Beauregard G (1981) The scapular crest pedicled bone graft. Int J Microsurg 3: 257–262
Thiel W (1992) Die Konservierung ganzer Leichen in natürlichen Farben — The preservation of entire cadavers in natural colors. Anat Anz (in press)
Weiland AJ (1990) Small joint arthrodesis and bony defect reconstruction. In: May JW, Littler JW (ed) The Hand, Plastic Surgery. WB Saunders, Philadelphia, pp 4671–4694
Zwipp H, Flory P, Berger A, Tscherne H (1989) Kombination von Spongiosaplastik und freier mikrovasculärer Konchentransplantation bei großen knöchernen Defekten. Handchirurgie 21: 235–245
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Pierer, G., Steffen, J. & Hoflehner, H. The vascular blood supply of the second metacarpal bone: anatomic basis for a new vascularized bone graft in hand surgery. Surg Radiol Anat 14, 103–112 (1992). https://doi.org/10.1007/BF01794884
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DOI: https://doi.org/10.1007/BF01794884