Pedicled vascularized bone graft of Kienböck disease. A, Anterior interosseous artery is ligated proximal to fourth and fifth extensor compartment arteries, and graft is elevated. After verifying blood flow, graft is shaped to fit dorsal opening to lunate. B, Cancellous bone is packed into lunate. Bone graft is inserted with pedicle placed vertically and cortical surface oriented proximal-distal. (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.)