Vascularized rib graft for proximal scaphoid reconstruction: An anatomical study

The loss of cartilaginous substance at the proximal pole of the scaphoid bone poses a therapeutic challenge, with 10% of fractures in this area progressing to pseudarthrosis and necrosis of the proximal pole. Our aim is to propose a conservative surgical alternative involving replacing the necrotic scaphoid with a vascularized osteochondral graft taken from the fourth rib. Angiography of the donor site was performed on seven hemithoraxes to analyze the osteochondral vascularization. Twenty vascularized osteochondral grafts were then performed on anatomical subjects after the proximal pole of the scaphoid was excised. The osteochondral vascularization of the donor site remained consistent, with the presence of a posterior intercostal collateral artery at each level. The harvested grafts averaged 3.1 cm in length and 1.2 cm in thickness. The average arterial diameter was 2.5 mm, the venous diameter was 3 mm, and the average pedicle length was 2.9 cm. We present a reliable and reproducible technique that offers satisfactory anatomical reconstruction. LEVEL OF EVIDENCE: V.