[Vascularized bone pedicle grafts of the hand and wrist: literature review and new donor sites].

Some situations in hand surgery require vascularized bone grafts. Good mechanical strength and decreased time for bone healing may explain their use. Although many donor sites have been described, the authors were interested by donor sites with a blood supply provided by an accessory vessel not disturbing the perfusion of the hand. Literature review of the different donor sites demonstrate (a) Three sites at the dorsal aspect of the distal epiphysis and one at the dorsal distal ulna. Only the radialmost site has been regularly used for surgical application. (b) At the palmar aspect of the radial epiphysis, the pronator quadratus vascularised bone graft may be elevated in an antero or retrograde way. (c) Among the carpal bones, the pisiform and part of the capitate has been used as pedickled bone graft. (d) Metacarpals may also be a donor site. Description of sites at the proximal and distal part of the second metacarpal has been used for surgical applications. The authors describe a new site at the first metacarpal at the radiodorsal or uino-dorsal aspect which may be used as a composite bone-skin graft. A clinical application is presented. Clinical use of these pedicles graft is discussed and apply mainly for scaphoid nonunion and some case of Kienbock's disease. Distal stump reconstruction is possible with the new flap.