Technique Optimization of Interposition Arthroplasty During Proximal Row Carpectomy with Regard to the Vascularity of the Capsule in Carpal Joint: Cadaverous Study

PURPOSE OF THE STUDY The study aimed to propose an optimal based flap creation with the view to ensure long-term survival of the interposition arthroplasty. MATERIAL AND METHODS A total of 28 dorsal wrist capsules were collected from 16 cadavers (with age range at death 18 to 80 years, with no visible wrist pathology). Altogether 112 histological specimens were obtained from these 28 samples. Post-hoc Dunn's tests were used to analyse the percentage of vascularisation of individual sides of the dorsal capsule (circumference and area) at the 0.05 level of significance. Spearmann's correlation analysis was used to assess the effect of age on vascularization of the dorsal wrist capsule. In cadavers in whom both capsules were collected, the limbs were compared. For the sake of comparison, the Wilcoxon matched pairs test was used. RESULTS Regarding statistical significance, the largest share of the total circumference and area of the measured vessels of the dorsal capsule is constituted by the distal side (35.2% of the circumference and 30.9% of the area). The blood supply of the dorsal capsule received on the ulnar side is the lowest (12.9% of the circumference and 17.6% of the area). There was no significant effect of age on vascularization of the dorsal wrist capsule confirmed. Also, the comparison of vascularization of both limbs from a single cadaver did not yield any statistically significant results. DISCUSSION Proximal row carpectomy is a long-established surgical technique used to manage the degenerative changes in the wrist. Our results showed the best vascularization on the distal and radial sides of the dorsal wrist capsule. In this light, the distally-based flap or the flap described by Berger, which respects the clinically important ligaments, appear to be the least invasive and help maintain the future stability of the wrist. CONCLUSIONS In clinical practice, we advise that a radially-based flap according to Berger is created and the distal side of the dorsal capsule, the most vascularized portion based on our results, is preserved as much as possible. The flap created in this manner also preserves the important carpal ligaments and appears to the authors of this study to be the most beneficial, also with respect to the presence of the largest arteries, contrary to the distal side. Another option is to use a distally-based flap for interposition arthroplasty.