Vascularized pedicle flaps for kienböck’s disease

Pedicled vascularized bone grafts (VBGs) are an effective option in the treatment of Kienböck’s disease. As tools in a surgeon’s armamentarium, they provide several advantages over conventional grafts including the ability to revascularize bone while preserving bone mass and strength. Pedicled VBGs may be used as the sole treatment in ulna neutral and ulna positive variance, or as an adjunct to joint leveling procedures in patients with ulna negative variance. They have been used in stage II, IIIA, and IIIB disease. Several different grafts based on various pedicles have been described. The 4 + 5 ECA is ideal secondary to its long pedicle length, large pedicle diameter, and relative ulnar location. Unloading of the lunate by scaphocapitate temporary pinning or arthrodesis is favored given the theoretical risk that early loads may hinder bone graft incorporation and revascularization. Lunate revascularization procedures are technically demanding, and though attractive, technical error and pedicle injury can contribute to failure.