Vascularized pedicle flaps for kienböck’s disease

William R. Aibinder, Alexander Y. Shin

Research output: Chapter in Book/Report/Conference proceedingChapter


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.

Original languageEnglish (US)
Title of host publicationKienbock's Disease
Subtitle of host publicationAdvances in Diagnosis and Treatment
PublisherSpringer International Publishing
Number of pages15
ISBN (Electronic)9783319342269
ISBN (Print)9783319342245
StatePublished - Jan 1 2016


  • 4 + 5 ECA
  • Pedicled vascularized bone grafts

ASJC Scopus subject areas

  • General Medicine


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