1. FIFTH EXTENSOR COMPARTMENT ARTERY VASCULARIZED ARTHROPLASTY FOR SCAPHOLUNATE LIGAMENT RECONSTRUCTION
F. Quatra, O.Romeo, D. Lowenberg, D. Brooks, F. Stagno D’Alcontres,
M. Colonna, Harry J. Buncke
The Buncke Clinic
San Francisco, California
Department of Plastic Surgery
University of Messina, Italy

2. Scope of the Problem
Lesions to the scapho-lunate ligament are the most frequent cause of carpal instability and a mayor cause of disability

3. The Scapho-Lunate Ligament

4. Current Alternatives Blatt’s capsulodesis Limited Wrist Fusions
Tendon Arthroplasties
(Primary reinsertion)

5. Hypothesis
A vascularized graft is expected to heal better than conventional reconstructions with non-vascularized capsule flaps or tendon rods.

6. Background
Dorsal wrist vascular anatomy
(Bishop, 1995)

7. Materials and Methods Ten fresh-frozen cadaver limbs
Vascular injection
Histology for: collagen
elastic fiber

12. 5th extensor compartment artery
Constant vessel
Caliber 0.6 mm
Under the floor of the 5th extensor compartment

13. Graft (pedicled fascia flap)
2x1 cm (from roof of 5th compartment*)
Pedicle = 4 cm long
Pivot point = 1 cm from Radiocarpal joint
Fixation = 2-3 transosseus sutures **
* Extensor digiti minimi fascia
** Mitek anchors?

14. Vascular Injection

15. Masson’s Trichromic Staining

16. Conclusions Anatomy fairly constant Sizable and strong graft
Microscopic structure and collagen comparable

17. Let’s try it! Thank You

18. Alternative: Posterior Interosseus Artery