title: A pedicled bone graft from the acromion: an anatomical investigation regarding surgical feasibility.
abstract: OBJECTIVE
  To investigate the technical feasibility of harvesting a vascularized bone graft from the acromion pedicled on the acromial branch.
  
  
  BACKGROUND
  Complex fractures of the proximal humerus may result in partial or total avascular necrosis of the head fragment. Treatment of avascular necrosis of the humeral head is dependent upon the stage of disease as well as the dimension and location of necrosis. In general, the outcome is poor and complete restoration of the shoulder function is rarely attained. Contrary to osteonecrosis of carpal bones (where vascularized bone grafts have been routinely carried out for decades), reports of analogous procedures at the humeral head are anecdotal.
  
  
  METHODS
  Based on selective post-mortem computer-tomographic angiography of 5 and the dissection of 30 embalmed human cadaver shoulders, we describe the anatomy of the acromial branch of the thoracoacromial trunk. The main focus was the constancy of its anatomical course, its dimensions and potential use as a nutrient vessel for a pedicled bone graft from the acromion.
  
  
  RESULTS
  The course of the acromial branch revealed a constant topographic relationship to anatomical landmarks. Its terminal branches reliably supplied the anterior part of the acromion. The vascularized bone graft could be sufficiently mobilized to allow tension-free transfer to the humeral head as well as to the lateral two-thirds of the clavicle.
  
  
  CONCLUSIONS
  We demonstrated the feasibility of vascularized bone graft harvesting from the acromion. This technique could be a joint-preserving procedure for osteonecrosis of the humeral head or may assist in the revision of a clavicular pseudoarthrosis.
authors: Department of Orthopaedic Surgery, Hôpital cantonal de Fribourg, Fribourg, Switzerland. bmoor@gmx.ch
authors: Beat Kaspar
authors: BK
authors: Moor
authors: Georges
authors: G
authors: Kohut
authors: Samy
authors: S
authors: Bouaicha
authors: Silke
authors: S
authors: Grabherr
authors: Emanuel
authors: E
authors: Gautier
authors: Mathias
authors: M
authors: Bergmann
authors: Nicholas
authors: N
authors: Marcer
authors: Valentin
authors: V
authors: Djonov
mesh_terms: D000174:Acromion / Q000033:anatomy & histology* / Q000637:transplantation*; D000368:Aged; D000369:Aged, 80 and over; D016025:Bone Transplantation; D002102:Cadaver; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D012784:Shoulder Fractures / Q000601:surgery*; D013524:Surgical Flaps