Vascularized bone grafts from the distal radius for disorders of the carpus

Vascularized bone grafts offer several distinct advantages over conventional, nonvascularized autografts. Because cell viability and structural integrity is maintained, primary bone healing may occur, rather than creeping substitution of necrotic bone. Cortical osteocyte viability is significantly higher than in nonvascularized grafts, approaching 90% of normal controls. Minimal bone necrosis results in less remodeling, maintained bone mass, and diminished osteopenia after transfer. Vascularized grafts also exhibit superior material properties including strength, toughness, and elastic modulus 2 to 4 times greater than conventional structural grafts. Revascularization and remodeling of adjacent avascular bone also is facilitated by living grafts. All of these properties make them attractive for treatment of some scaphoid nonunions as well as carpal avascular necrosis. The principles, anatomy, application, experimental, and clinical studies of carpal vascularized pedicled bone grafts are the focus of this article.