Article

The author specifies the aims and indications for simple or compound pedicle or
free vascularised bone and bone and joint grafts (VBGs and VBJGs). He relates the
history of VBGs whose indications for the wrist are often many and varied for the
treatment of scaphoid non-union and Kienboch's disease. Within the hand the
indication for compound VBGs is dominated by thumb reconstruction (skin and bone
grafts). Compound VBGs and VBJGs used in an emergency for hand trauma, harvested
from another irrecoverable long finger (bank finger) are extremely varied and
adapted to each particular case. For secondary joint reconstruction in the adult,
VBJGs must be discussed along with prosthetic arthroplasties (radio-carpal, lower
radio-ulnar, trapezo-metacarpal, interphalangeal).
For children VBJGs with an
included growth plate maintain their indication. The immediate future of VBGs is
that of a better knowledge of bone necrosis and bone innervation as well as an
improvement in surgical techniques: microsurgery and robotics, mini-invasive
surgery (wrist arthroscopy). The near future for VBGs is to control bone
consolidation thanks to progress in the bio-engineering of bone tissue, which may
make them obsolete and, for VBJGs, vascularised joint allografts, thanks to
progress in immunosuppressant treatments. Although the immediate future and this
near future may be envisaged according to the current advances, the same is not
true for the distant future which remains totally unforeseeable, although this
might involve regeneration and construction of organs by man himself.
CI - Copyright (c) 2010 Elsevier Masson SAS. All rights reserved.

Langue : FRANCAIS