{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T10:02:32Z","timestamp":1753869752560,"version":"3.41.2"},"reference-count":45,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T00:00:00Z","timestamp":1698192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Free vascularized bone grafting (FVBG) has become one of the essential methods for treating scaphoid nonunion complicated by avascular necrosis. However, commonly used bone graft, including the medial femoral condyle bone graft and iliac crest bone graft, still present challenges such as a high rate of donor site complications and variations of vascular pedicle. In this study, we have introduced a novel bone graft\u2014the lateral humeral condyle bone graft with the posterior branch of the radial collateral artery (PBRCA) as the vascular pedicle\u2014as an alternative option, with the aim of overcoming some of the limitations of previously described FVBG procedures.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Nine patients who had a nonunion of the scaphoid that had been present for an average of 16.8\u2009months (range 9\u201335\u2009months) were managed with use of a free vascularized bone graft obtained from the lateral humeral epicondylar region. Avascularity of the scaphoid, as assessed on preoperative magnetic resonance imaging and intraoperative bone marrow puncture test. Postoperatively, regular X\u2010ray and CT scans examinations were conducted to assess the progress of fracture healing. Active motion of the wrist, and grip strength recovery were measured periodically. Wrist pain was graded using the Visual Analogue Scale (VAS), while wrist joint functionality was evaluated using the Quick Disabilities of the Arm, Shoulder, and Hand (Quick\u2010DASH) questionnaire and the Patient\u2010Rated Wrist Evaluation (PRWE) scale. The elbow functional outcome was evaluated by the Mayo Elbow Performance Score (MEPS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All of nine lateral humeral epicondylar bone grafts were successfully harvested. The blood supply of the graft during surgery was excellent in six cases and good in three cases. The size of the bone grafts ranges from 1.0\u2009cm\u2009\u00d7\u20090.5\u2009cm\u2009\u00d7\u20090.5\u2009cm to 2.0\u2009cm\u2009\u00d7\u20091.0\u2009cm\u2009\u00d7\u20090.5\u2009cm. The average vascular pedicle length was 3.4\u2009cm (range 2.0\u20136.0\u2009cm). There were no early complications in either the donor or recipient areas after surgery. Union was successfully achieved in all nine patients, with an average time to union of 14.3\u2009weeks (range 11\u201320\u2009weeks) after surgery. The average follow\u2010up period was 31.2\u2009months (range 26\u201340\u2009months). At the final follow\u2010up, the average palmar flexion, dorsal extension, radial deviation, and ulnar deviation angles of the injured wrist joint were 56.1\u00b0 (range 45\u00b0\u201370\u00b0), 56.1\u00b0 (range 40\u00b0\u201380\u00b0), 10.6\u00b0 (range 5\u00b0\u201320\u00b0), and 22.2\u00b0 (range 15\u00b0\u201335\u00b0), respectively, which reached 79.0%, 82.1%, 59.4%, and 72.8% of the average activity of the contralateral normal side. The average grip strength of the injured side was 35.2\u2009kg (range 22\u201351\u2009kg), which was equivalent to 81.3% of the average grip strength of the contralateral side. The average VAS score for wrist joint pain was 1.0 point (range 0\u20132 points); the Quick\u2010DASH score was 9.2 points (range 6\u201318 points); and the PRWE score was 13.1 points (range 9\u201316 points), the Mayo Elbow Performance Index was 100 points (range 100\u2013100 points). One patient reported a feeling of friction during movement but no pain. One patient reported numbness in the donor site. One patient complained of pain when applying force to the scar in the donor area. During the follow\u2010up period, these complications showed improvement without any treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The FVBG technique has been considered an effective method for treating scaphoid nonunion with avascular necrosis. Compared to traditional FVBG, the lateral humeral epicondylar bone graft exhibits a higher union rate, fewer complications, and easier accessibility, making it a favorable choice.<\/jats:p><\/jats:sec>","DOI":"10.1002\/micr.31128","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T11:21:35Z","timestamp":1698232895000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Free vascularized bone graft from the lateral epicondylar region of the humerus for treatment of scaphoid nonunion"],"prefix":"10.1002","volume":"44","author":[{"given":"Nuo","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital Central South University  Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuling","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital Central South University  Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4956-0573","authenticated-orcid":false,"given":"Juyu","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Hand and Microsurgery, Xiangya Hospital Central South University  Changsha Hunan China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/1558944717736397"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749-799X-9-21"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/0266-7681(91)90011-C"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2020.06.013"},{"issue":"5","key":"e_1_2_10_6_1","first-page":"1038","article-title":"Development of the QuickDASH: Comparison of three item\u2010reduction approaches","volume":"87","author":"Beaton D. 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