2,3 intercompartmental supraretinacular artery pedicled vascularized bone graft for scaphoid nonunions

Scaphoid nonunion is a complex problem that may continue to exist despite conventional methods of bone grafting and internal fixation. Vascularized bone grafting has been proposed as a treatment option for scaphoid nonunions with or without avascular necrosis of the proximal pole. Zaidemberg and colleagues first introduced the dorsal distal radius graft that has gained considerable popularity in the past 2 decades. Less commonly, the 2,3 intercompartmental supraretinacular artery pedicled vascularized bone graft has been used successfully with equally promising results. It has become the graft of our choice for the treatment of scaphoid nonunions as it has a longer pedicle and is able to provide a wider arc of rotation that allows easier reach of the volar carpus. The use of rigid internal fixation with screws also permitted early wrist range of motion and shorter periods of immobilization. In this article, we describe our surgical technique of harvesting the 2,3 intercompartmental supraretinacular artery pedicled vascularized bone graft. The anatomy, indications, contraindications, and complications of treatment are also detailed.