[Possibilities for revascularization in early and late stage lunate malacia]

There are various biomechanical procedures for the treatment of lunate necrosis in the literature, but only a few deal with the possible revascularisation of the bone. We used the second dorsal metacarpal vascular bundle implantation technique in different stages of Kienböck's disease. Since 1990, twelve patients were treated by this method. In stage I-II according to Lichtman, we implanted the vessels in the lunate after excochleation and cancellous bone grafting, in stage III we used a modified form of the Graner operation and revascularised the proximalised part of the capitate. In the first group, six patients, we observed significant improvement in five cases clinically, radiologically confirmed stagnation of the process in four cases. In the second group of six patients, the clinical symptoms improved in four cases, three patients had to change work and one patient developed a pseudarthrosis between the capitate and corticocancellous block, but the proximalised part of capitate survived in all cases. Vascular bundle implantation can be a helpful method in early stages of lunate necrosis, helping to slow or to stop the progression of the disease.