Anatomy of pisiform blood supply and feasibility of vascularized pisiform transfer for avascular necrosis of lunate based on digital technique_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XU Yujian ¹ ,  XU Yongqing ² , LUO Haotian ² , HE Xiaoqing ² , ZHANG Xulin ² , ZHAO Wanqiu ² , WU Huan ¹ , YUAN Libo ²

1. The Graduate School, Army Military Medical University, Chongqing, 400000, P.R.China;
2. Department of Orthopeadics, the 920th Hospital of Joint Logistics Support Force, Kunming Yunnan, 650032, P.R.China;

Corresponding author：

XU Yongqing, Email: xuyongqingkm@163.net

Keywords：

Avascular necrosis of lunate; Kienböck’s disease; pisiform; vascularized bone trasfer; anatomy

DOI：

10.7507/1002-1892.201907128

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Objective To provide anatomical basis for vascularized pisiform transfer in the treatment of advanced avascular necrosis of the lunate (Kienböck’s disease) by studying its morphology and blood supply pattern based on digital technique.Methods Twelve adult fresh wrist joint specimens were selected and treated with gelatin-lead oxide solution from ulnar or radial artery. Then the three-dimensional (3D) images of the pisiform and lunate were reconstructed by micro-CT scanning and Mimics software. The morphologies of pisiform and lunate were observed and the longitudinal diameter, transverse diameter, and thickness of pisiform and lunate were measured. The main blood supply sources of pisiform were observed. The number, diameter, and distribution of nutrient foramina at proximal, distal, radial, and ulnar sides of pisiform were recorded. The anatomic parameters of the pedicles (branch of trunk of ulnar artery, carpal epithelial branch, descending branch of carpal epithelial branch, recurrent branch of deep palmar branch) were measured, including the outer diameter of pedicle initiation, distance of pedicle from pisiform, and distance of pedicle from lunate. Results There were significant differences in the longitudinal and transverse diameters between pisiform and lunate (t=6.653, P=0.000; t=6.265, P=0.000), but there was no significant difference in thickness (t= 1.269, P=0.109). The distal, proximal, radial, and ulnar sides of pisiform had nutrient vessels. The nutrient foramina at proximal side were significantly more than that at distal side (P<0.05), but there was no significant difference in the diameter of nutrient foramina between different sides (P>0.05). The outer diameter of pedicle initiation of the recurrent branch of deep palmar branch was significantly smaller than the carpal epithelial branch and descending branch of carpal epithelial branch (P<0.05). There was no significant difference in the distance of pedicle from pisiform/lunate between branch of trunk of ulnar artery and recurrent branch of deep palmar branch (P>0.05), and between carpal epithelial branch and descending branch of carpal epithelial branch (P>0.05). But the differences between the other vascular pedicles were significant (P<0.05). Conclusion There are abundant nutrient vessels at the proximal and ulnar sides of pisiform, so excessive stripping of the proximal and ulnar soft tissues should be avoided during the vascularized pisiform transfer. It is feasible to treat advanced Kienböck’s disease by pisiform transfer with the carpal epithelial branch of ulnar artery and the descending branch.

Citation： XU Yujian, XU Yongqing, LUO Haotian, HE Xiaoqing, ZHANG Xulin, ZHAO Wanqiu, WU Huan, YUAN Libo. Anatomy of pisiform blood supply and feasibility of vascularized pisiform transfer for avascular necrosis of lunate based on digital technique. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 596-601. doi: 10.7507/1002-1892.201907128 Copy

1.	Beck E. Transfer of pisiform bone on vascular pedicle in the treatment of lunatomalacia. Handchirurgie, 1971, 3(2): 64-67.
2.	Saffar P. Replacement of the semilunar bone by the pisiform. Description of a new technique for the treatment of Kienböeck’s disease. Ann Chir Main, 1982, 1(3): 276-279.
3.	Ishii H, Tatebe M, Hirata H. Distal radius joint surface reconstruction using a pedicle pisiform osteochondral transfer. J Hand Surg (Am), 2015, 40(10): 2075-2080.
4.	Saffar P. Vascularized pisiform transfer in place of lunatum for Kienböck’s disease. Chir Main, 2010, 29 Suppl 1: S112-S118.
5.	Daecke W, Lorenz S, Wieloch P, et al. Vascularized os pisiform for reinforcement of the lunate in Kienböck’s disease: an average of 12 years of follow-up study. J Hand Surg (Am), 2005, 30(1): 915-922.
6.	Tan Z, Xiang Z, Huang F, et al. Long-term results of vascularized os pisiform transfer for advanced Kienböck disease after follow-up for at least 15 years. Medicine (Baltimore), 2018, 97(48): e13229.
7.	吴强, 高雁卿, 陈跃军. 保留月骨骨壳带蒂豌豆骨植入治疗月骨无菌性坏死. 中国骨与关节损伤杂志, 2005, 20(11): 775.
8.	刘有余, 姚忠军, 郑和平, 等. 尺动脉腕上皮支降支蒂豌豆骨移位替代月骨的解剖基础. 中国临床解剖学, 2008, 26(2): 131-133.
9.	Zlotorowicz M, Czubak J, Kozinski P, et al. Imaging the vascularization of the femoral head by CT angiography. J Bone Joint Surg (Br), 2012, 94(9): 1176-1179.
10.	Kingston MJ, Perriman DM, Neeman T, et al. Contrast agent comparison for three dimensional micro CT angiography: A cadaveric study. Contrast Media Mol Imaging, 2016, 11(4): 319324.
11.	杨曦, 徐永清, 何晓清, 等. 数字化技术制备大鼠跨区穿支皮瓣微小血管模型的实验研究. 中国修复重建外科杂志, 2017, 31(12): 1485-1489.
12.	van Alphen NA, Morsy M, Laungani AT, et al. A three-dimensional micro-computed tomographic study of the intraosseous lunate vasculature: implications for surgical intervention and the development of avascular necrosis. Plast Reconstr Surg, 2016, 138(5): 869e-878e.
13.	Kadar A, Morsy M, Sur YJ, et al. The vascular anatomy of the capitate: new discoveries using micro-computed tomography imaging. J Hand Surg (Am), 2017, 42(2): 78-86.
14.	王鼎予, 李旭, 沈重成, 等. microCT 下钩骨骨内微小动脉三维构筑的临床解剖学研究. 北京大学学报 (医学版), 2018, 50(2): 245-248.
15.	Xiao ZR, Zhang WG, Xiong G, et al. Three dimensional intralunate arteries visualization with red lead (Pb₃O₄) angiography. Chin Med J (Engl), 2017, 130(21): 2575-2578.

1. Beck E. Transfer of pisiform bone on vascular pedicle in the treatment of lunatomalacia. Handchirurgie, 1971, 3(2): 64-67.
2. Saffar P. Replacement of the semilunar bone by the pisiform. Description of a new technique for the treatment of Kienböeck’s disease. Ann Chir Main, 1982, 1(3): 276-279.
3. Ishii H, Tatebe M, Hirata H. Distal radius joint surface reconstruction using a pedicle pisiform osteochondral transfer. J Hand Surg (Am), 2015, 40(10): 2075-2080.
4. Saffar P. Vascularized pisiform transfer in place of lunatum for Kienböck’s disease. Chir Main, 2010, 29 Suppl 1: S112-S118.
5. Daecke W, Lorenz S, Wieloch P, et al. Vascularized os pisiform for reinforcement of the lunate in Kienböck’s disease: an average of 12 years of follow-up study. J Hand Surg (Am), 2005, 30(1): 915-922.
6. Tan Z, Xiang Z, Huang F, et al. Long-term results of vascularized os pisiform transfer for advanced Kienböck disease after follow-up for at least 15 years. Medicine (Baltimore), 2018, 97(48): e13229.
7. 吴强, 高雁卿, 陈跃军. 保留月骨骨壳带蒂豌豆骨植入治疗月骨无菌性坏死. 中国骨与关节损伤杂志, 2005, 20(11): 775.
8. 刘有余, 姚忠军, 郑和平, 等. 尺动脉腕上皮支降支蒂豌豆骨移位替代月骨的解剖基础. 中国临床解剖学, 2008, 26(2): 131-133.
9. Zlotorowicz M, Czubak J, Kozinski P, et al. Imaging the vascularization of the femoral head by CT angiography. J Bone Joint Surg (Br), 2012, 94(9): 1176-1179.
10. Kingston MJ, Perriman DM, Neeman T, et al. Contrast agent comparison for three dimensional micro CT angiography: A cadaveric study. Contrast Media Mol Imaging, 2016, 11(4): 319324.
11. 杨曦, 徐永清, 何晓清, 等. 数字化技术制备大鼠跨区穿支皮瓣微小血管模型的实验研究. 中国修复重建外科杂志, 2017, 31(12): 1485-1489.
12. van Alphen NA, Morsy M, Laungani AT, et al. A three-dimensional micro-computed tomographic study of the intraosseous lunate vasculature: implications for surgical intervention and the development of avascular necrosis. Plast Reconstr Surg, 2016, 138(5): 869e-878e.
13. Kadar A, Morsy M, Sur YJ, et al. The vascular anatomy of the capitate: new discoveries using micro-computed tomography imaging. J Hand Surg (Am), 2017, 42(2): 78-86.
14. 王鼎予, 李旭, 沈重成, 等. microCT 下钩骨骨内微小动脉三维构筑的临床解剖学研究. 北京大学学报 (医学版), 2018, 50(2): 245-248.
15. Xiao ZR, Zhang WG, Xiong G, et al. Three dimensional intralunate arteries visualization with red lead (Pb₃O₄) angiography. Chin Med J (Engl), 2017, 130(21): 2575-2578.

Chinese Journal of Reparative and Reconstructive Surgery

Anatomy of pisiform blood supply and feasibility of vascularized pisiform transfer for avascular necrosis of lunate based on digital technique

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