The Free Distal Clavicle Osteochondral Flap: Cadaveric Dissection and Case Report to Introduce a Novel Technique

Vascularized osteochondral flap reconstruction is an innovation with several potential benefits, but there are limited described autologous donor site options. This study explores the distal clavicle as a viable donor site for vascularized free osteochondral tissue transfer. Cadaveric dissection was performed in which a 39-year-old male with a comminuted fracture of the right distal humerus underwent open reduction and internal fixation. The patient later presented with avascular necrosis of the lateral column of the distal humerus and right trochlea and underwent reconstruction of the distal humerus with iliac crest bone graft and vascularized free osteochondral transfer of the distal clavicle. The distal clavicle was harvested with its periosteum and a small muscle cuff based on the acromial branch of the thoracoacromial system. The authors report a novel technique for distal clavicle osteochondral flap harvest and present a case in which the technique was used successfully in complex elbow reconstruction.