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The vascular blood supply of the second metacarpal bone: anatomic basis for a new vascularized bone graft in hand surgery

Vascularisation du deuxième métacarpien. Bases anatomiques pour un nouveau greffon vascularisé en chirurgie de la main

An anatomical study in cadavers

  • Anatomical Bases Of Medical, Radiological And Surgical Techniques
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Summary

After traumatic loss of the index finger the second metacarpal bone is often used as a free graft to reconstruct bony defects of the thumb. Since clinical experience has shown numerous advantages of using a blood supplied bone graft, an anatomical study was performed in 104 cadaveric hands to investigate the vascularization supply of this bone. After dye injections into the arterial system the vascular situation of the second metacarpal was studied and a classification was made. Six variations in arterial vascularization were found. The nutrient vessels to the bone originate from the radial artery or from the deep palmar arch and correspond to variable metacarpal arteries. Selective injection studies via the respective pedicles showed sufficient perfusion and complete dye distribution in the bone. Further dissections could demonstrate the feasibility of raising a pedicled bone graft only partially with preservation of the index finger. The second metacarpal as a vascularized graft may be harvested entirely in serious injuries with destruction of the index finger in emergency cases of skeletal thumb reconstruction or partially as an elective procedure. All type have a useful are of rotation and their pedicles allow transpositions within the radial side of the hand, especially for applications in the thumb and carpus. The clinical application of these procedures could be shown in five cases. The results of this study therefore provide the anatomical basis for transposition or free microvascular transplantation of the second metacarpal as a vascularized bone graft for a variety of indications in hand surgery.

Résumé

Après une perte de substance osseuse post traumatique du pouce associée à une perte de l'index, un greffon osseux vascularisé est souvent utilisé pour reconstruire le pouce à partir du deuxième métacarpien. Un transfer osseux présente des avantages quand il est vascularisé. Pour cette raison les auteurs ont étudié, sur 104 mains prelevées sur des cadavres, les bases anatomiques et les possibilités d'une transposition du métacarpe II avec un pédicule vasculaire. Après l'injection intraartérielle, la vascularisation du 2eme métacarpien II a été étudiée et une classification a été faite. Les auteurs ont trouvé six variantes différentes. Les artères nourricières proviennent de l'a. radiale ou de l'arcade palmaire profonde et forment les aa. métacarpiennes de situation variable. Des injections sélectives avec bleu de méthylène dans les artères ont prouvé les bonnes conditions de perfusion avec une diffusion du la substance colorante dans l'os entier. La longueur des pédicules vasculaires permet une rotation correcte de ce transfert osseux sur le versant radial de la main dans chaque variante, plus particulièrement dans le cas des applications au pouce et à la racine de main. Les résultats de ces recherches constituent la base anatomique pour une nouvelle méthode reconstructive dans la chirurgie de la main.

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Authors and Affiliations

  1. Department of Plastic Surgery, Medical School, Karl Franzens University, Auenbruggerplatz 29, A-8036, Graz, Austria

    G Pierer & H Hoflehner

  2. Anatomisches Institut, Karl Franzens Universität, Harrachgasse 21, A-8010, Graz, Austria

    J Steffen

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  1. G Pierer
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  2. J Steffen
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  3. H Hoflehner
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Pierer, G., Steffen, J. & Hoflehner, H. The vascular blood supply of the second metacarpal bone: anatomic basis for a new vascularized bone graft in hand surgery. Surg Radiol Anat 14, 103–112 (1992). https://doi.org/10.1007/BF01794884

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  • DOI: https://doi.org/10.1007/BF01794884

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