Potential Donor Rotational Bone Grafts Using Vascular Territories in the Foot and Ankle

by Brett J. Gilbert, Frank Horst, and James A. Nunley

J Bone Joint Surg AmVolume 86(9):1857-1873

September 1, 2004

©2004 by The Journal of Bone and Joint Surgery, Inc.

Overview of the extraosseous blood supply to the foot and ankle.

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

A: Anterolateral view of the extraosseous blood supply to the foot and ankle. 1 = tibia, 2 = fibula, 3 = talus, A = anterior tibial artery, B = lateral metaphyseal artery, C = medial metaphyseal artery,

D = perforating peroneal artery, E = anterior lateral ...

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

A: The dorsal extraosseous blood supply to the cuboid. 1 = third cuneiform, 2 = cuboid, 3 = calcaneus, 4 = os peroneum, A = proximal lateral tarsal artery, B = longitudinal branch to the

third intermetatarsal space, C = transverse pedicle branch, D = longit...

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

A: The extraosseous blood supply to the medial aspect of the first cuneiform. 1 = first cuneiform, 2 = second cuneiform, 3 = navicular, 4 = base of the first metatarsal, A = proximal medial tarsal

artery, B = distal medial tarsal artery, C = superomedial bo...

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

A: The extraosseous blood supply to the dorsal surface of the second and third cuneiforms. 1 = navicular, 2 = second cuneiform, 3 = third cuneiform, 4 = cuboid, A = dorsalis pedis artery, B =

distal medial tarsal artery, C = medial hook of the necklace to t...

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

A: The vascular territory in the cuboid supplied by the transverse pedicle branch of the proximal lateral tarsal artery.

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

A: The vascular territory in the lateral malleolus supplied by the transverse segment of the anterior lateral malleolar artery.

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

A: The vascular territory in the first cuneiform supplied by the middle pedicle branch of the distal medial tarsal artery.

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

A: The vascular territory in the third cuneiform supplied by the transverse branch of the distal lateral tarsal artery.

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

The midfoot of a forty-seven-year-old woman with a nonunion of an old complete stress fracture in the lateral one-third of the navicular.

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

The rotational vascularized pedicle bone graft harvested from the third cuneiform in Figure 10-A has been press-fit into a trough over the nonunion site in the navicular.

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.

Computerized tomographic scans made preoperatively (A), showing the nonunion, and eleven months postoperatively (B), showing union of the fracture.

Brett J. Gilbert et al. J Bone Joint Surg Am 2004;86:1857-1873

©2004 by The Journal of Bone and Joint Surgery, Inc.