Does Anyone Need a Vascularized Graft?

Hand Clin. 2019 Aug;35(3):323-344. doi: 10.1016/j.hcl.2019.03.005. Epub 2019 May 11.


Many hand surgeons argue that vascularized bone grafting is indicated in proximal pole avascular necrosis, prior failed surgery, or long-standing scaphoid nonunion. However, the available evidence does not support improved treatment outcomes for vascularized bone grafting rather than traditional nonvascularized techniques. This article addresses the available evidence and examines the role of vascularized bone grafting in scaphoid nonunion treatment. It also identifies important factors that influence healing, clarifies the decision-making algorithm, and proposes areas for further research.

Keywords: Avascular necrosis; Creeping substitution; Infarction; Ischemia; Nonvascularized bone graft; Scaphoid nonunion; Vascularity; Vascularized bone graft.

Publication types

  • Review

MeSH terms

  • Bone Transplantation / methods*
  • Fracture Fixation, Internal
  • Fracture Healing
  • Fractures, Bone / surgery*
  • Fractures, Ununited / surgery
  • Humans
  • Scaphoid Bone / injuries
  • Scaphoid Bone / surgery*