Free vascularized bone graft for nonunion of the scaphoid

We used a free vascularized small periosteal bone graft to treat scaphoid n onunion. The graft consisted of periosteum, full-thickness cortex, and the underlying cancellous bone and was harvested from the supracondylar region of the femur. The graft was nourished by the articular branch of the descen ding geniculate artery and vein. Unlike the currently used vascularized bon e grafts, this graft can be easily harvested and shaped to accommodate the bone defect of the scaphoid without disturbing its vascularity and can then be transferred with microvascular anastomosis of the nutrient vessels to t he radial artery and its venae commitantes. Ten patients with longstanding nonunion of the scaphoid secondary to avascular necrosis, confirmed by radi ologic and intraoperative findings, were treated with this vascularized bon e graft. Union was achieved in all 10 patients at an average of 12 weeks af ter surgery. The average follow-up period for all fractures was 3.5 years. The scores for overall outcome, according to the Mayo wrist scoring system, were excellent in 4 patients, good in 4, and fair in 2. Two unsatisfied pa tients had preoperative signs of early periscaphoid osteoarthrosis. This fr ee vascularized small bone graft from the supracondylar region of the femur is an attractive alternative to the conventional vascularized bone graftin g procedures. (J Hand Surg 2000;25A:507-519. Copyright (C) 2000 by the Amer ican Society for Surgery of the Hand.).