Pedicled vascularized bone graft for scaphoid nonunion. A, Incision (solid green line) exposes scaphoid and bone graft donor site. Subcutaneous tissues are raised from extensor retinaculum, and 1,2 intercompartmental supraretinacular artery (ICSRA) is identified. R, radius; RA, radial artery; S, scaphoid. B, Branches (I, II, III) of superficial branch of the radial nerve (SBRN) are identified and protected. Dashed lines indicate incisions of first and second extensor compartments. C, With graft levered out, tourniquet is deflated, and vascularity of graft is checked. D, Graft is gently press-fit into scaphoid nonunion site. Supplemental fixation with Kirschner wires or placement of scaphoid screws can be done at this time. (Redrawn from Shin AY, Bishop AT: Pedicled vascularized bone grafts for disorders of the carpus: nonunion and Kienböck’s disease, J Am Acad Orthop Surg 10:210, 2002. Adapted with permission from the Mayo Foundation, Rochester, MN.) SEE TECHNIQUE 69.17.