Vascularized Olecranon Bone Graft: An anatomical study and novel technique
Kai J Yang, MD1; Lucas M Boehm, MD2; David Rivedal, MD2; Ji-Geng Yan, MD, PhD2; Hani Matloub, MD3
1Medical College of Wisconsin, Milwaukee, WI, 2Medical College of Wisconsin, Wauwatosa, WI, 3Plastic Surgery, Medical College of Wisconsin, Milwaukee, WI
Background: Autologous bone grafting is commonly used in reconstructive hand surgery. Various sources of non-vascularized autologous bone grafts have been described in the literature. This includes anterior and posterior iliac crest, distal radius, tibia, cranium, etc. Olecranon bone grafting has been described in literature however it has not gained wide spread popularity in hand surgery. Proponents of olecranon bone grafting point out that it offers proximity and ease of harvest, avoidance of major neurovascular structures, well-hidden donor site scars and low post-op complications. However, non-vascularized bone grafting is at times inadequate in some situations where a vascularized bone graft may be needed. Popular vascularized bone grafts are taken from distal radius, iliac crest and medial femoral condyle. We aim to describe a novel technique of harvesting vascularized olecranon bone graft.
Methods: 13 fresh frozen cadaveric upper extremities were obtained. Latex was injected via the brachial artery to facilitate visualization of perforators in 10 specimens. Dissections of the olecranon are done noting all the periosteal perforators. The length and diameters of the perforators were recorded. Harvest of corticocancellous bone flaps with attached supplying perforators was performed. Flap dissection was then done in 3 fresh specimens and Indian ink was injected through the pedicle to demonstrate perfusion of the harvested bone flap.
Results: There's consistent vascular anatomy that supply the olecranon. A perforator from the posterior ulnar recurrent artery supplies the proximal ulnar and olecranon, from which a vascularized corticocancellous bone flap can be harvested. Branches to the flexor carpi ulnaris muscle allow harvest of chimeric flaps. Average pedicle length is 5.9cm and average diameter of arterial pedicle is 2.3mm. Indian ink injection of the pedicle showed perfusion of the periosteum as well as intra-osseous cancellous bone.
Conclusion: A vascularized olecranon free flap can be harvested based on the posterior ulnar recurrent artery. Vascular anatomy is consistent and will offer many of the same benefits as its non-vascularized counterpart while boasting a much more robust blood supply.
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