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

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

The Scapho-Lunate Ligament

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

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

Background Dorsal wrist vascular anatomy (Bishop, 1995)

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

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

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?

Vascular Injection

Masson’s Trichromic Staining

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

Let’s try it! Thank You

Alternative: Posterior Interosseus Artery