Francisco del Piñal, M.D., Dr. Med.

ASSH Surgical Anatomy: Flap Reconstruction chapter 44 321-336, 2018. Edited by Kevin C. Chung, MD, MS and Steven L. Moran, MD – Copyright © 2018 American Society for Surgery of the Hand (ASSH).

INTRODUCTORY PARAGRAPH (full text pdf. below)

Vascularized Joint and Hemi-Joint Flap

Nonvascularized joint and osteochondral reconstruction have poor long-term outcomes. Although the superficial layers of the cartilage are nourished by the synovial fluid, the deep layers—where Sharpey fibers insert—are dependent on the blood supply of the subchondral bone. Publications reporting short-term success with nonvascularized joint transfers have added some confusion to this issue: the process of cartilage delamination and joint collapse takes time, often more than 1 year (Fig. 44-1). Conversely, vascularized joints maintain their joint spaces over the long-term follow-up. Unfortunately, vascularized joint transfer is a complex operation, full of technical traps, and hence the indication should be limited; however, results in
selected patients are very satisfying. In children, there is no other way of providing a joint and growth potential in case
of trauma (Fig. 44-2).