Microsurgery in wrist and hand non-union and bone necrosis

The treatment of non-union and avascular necrosis still today represents a challenge for hand surgeons. Main condition to treat and treatment options: vascularized bone grafts are used in carpal pathologies as much to facilitate and accelerate healing as to revascularize ischemia. Generally, and always more frequently, they are used in scaphoid non-union, Preiser disease and Kienbock disease treatment. Surgical techniques principles: main pedicle bone grafts are from the dorsal and volar distal radius; there are also free flap options, particularly the medial femoral trochlea and condyle. Complications: possible complications are the bone graft loss of vascularization, the bone graft extrusion and the peripedicle heterotopic ossification. The results demonstrated by vascularized bone grafts are making the method increasingly more appreciated and widespread, with a constant extension of its use both in more extreme conditions than in more benign ones.