.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.gif)
.jpg)
Outcome of “Vascularized Bone Graft Spare Parts” Reconstruction of Segmental Metacarpal Deficits of Hand
Keywords:
Digital spare parts, segmental metacarpal deficits, single or double digital artery basis, vascularized bone grafts.Abstract
Objective: To determine the radiological and functional outcome of “vascularized bone graft spare parts” fashioned from severely damaged but viable parts of the hand and used for reconstruction of hand defects.
Methods: This descriptive study was conducted from 3rd January 2014 to 25th January 2018 in Millat Orthopaedic and Trauma Surgery Hospital Sargodha. All patients with traumatic hand defects fulfilling the inclusion criteria were reconstructed with vascularized bone graft spare parts technique. Patients were followed regularly for viability of graft, bone union and functions of the hand.
Results: A total of 6 patients with mean age 33.3 years (range 19 to 45 years) were included in our study. The aetiology of hand trauma was saw cut in 2(33.3%), crush injury in 2(33.3%), firearm in 1(16.6%) and sepsis in 1(16.6%) patient. Segmental defects in the first metacarpal were present in 3(50%) patients, first and third metacarpal in 2(33.3%) and third metacarpal in 1(16.6%) patient. Vascularized bone graft spare part pedicle of index phalangeal osteocutaneous was used in 6 patients, 2nd metacarpal osseous in 1(16.6%) and ring phalangeal osteocutaneous in 1 (16.6%). The average length of harvested bone graft used was 4.13cm (Range 3 to 5.5cm). All the flaps survived and bones united. Acceptable hand functions were restored in 4(66.6%) and mangled hand in 2(33.3%) patients. All patients resumed their work status and functional results were satisfactory.
Conclusion: Severely damaged and complex hand injuries treated with vascularized bone graft spare parts technique had good radiological and functional outcome. We, therefore recommend that vascularized bone graft pedicle spare parts of a severely injured hand should be innovated as a possible source for one stage reconstruction of the hand.
References
2. Swartz WM. Immediate reconstruction of the wrist and dorsum of the hand with free osteocutaneous groin flap. The Journal of Hand Surgery 1984; 9A: 18-21.
3. Pinal F. Severe mutilating injuries to the hand: guidelines for organizing the chaos. J Plast Reconstr Aesthet Surg 2007; 60:816-27
4. Muzaffar AR, Chao JJ, Friedrich JB.Post-traumatic thumb reconstruction. Plast Reconstr Surg 2005; 116(5):103-122.
5. Matev I.Thumb metacarpal lengthening. Tech Hand Up Extrem Surg 2003; 7(4):157-163.
6. Elbeshbeshy B, Paksima N. Post-traumatic thumb reconstruction. Bull Hosp Jt Dis 2001;60(3-4):130-133.
7. Lister G.The choice of procedure following thumb amputation. Clin Orthop Relat Res 1985:45-51.
8. Bstrup LT, Fredrickson JM. Distant transfer of a free, living bone graft by microvascular anastomoses. Plast Reconstr Surg 1974; 54: 274-285.
9. Han CS, Wood MB, Bishop AT, Cooney WP III. Vascularized bone transfer. J Bone Joint Surg Am 1992;74(10):1441-1449.
10. Fujimaki A, Suda H. Experimental study and clinical observations on hypertrophy of vascularized bone grafts. Microsurgery 1994; 15(10):726-732.
11. Hoflehner H, Pierer G, Steffen J. Skeletal thumb reconstruction by vascularized metacarpal II transposition. Anatomic study and clinical case reports. Handchir Mikrochir Plast Chir 1991; 23:82- 89.
12. Pierer G, Steffen J, Hoflehner H. The vascular blood supply of the second metacarpal bone: anatomic basis for a new vascularized bone graft in hand surgery. Surg Radiol Anat 1992; 14:103-112.
13. Bengoechea-Beeby MP, Cepeda-Una J, Abascal-Zuloaga A. Vascularized bone graft from the index metacarpal for Kienbock’s disease: a case report. J Hand Surg 2001;26A:437-443.
14. Voche P. Island bone graft from the second metacarpal to the first metacarpal. Chir Main 2002; 21: 46 -50.
15. Coban YK, Uzel M, Cetinus E. The use of vascularized phalanx for the first metacarpal bone defect in a mutilating hand injury. Case report. Ann Chir Plast Esthet 2006; 51:235-238.
16. Verolino P, Casoli V, Kostopoulos E, Castede JC, Pelissier P, Martin D, et al. Second to third phalanx vascularized bone transfer. Plast Reconstr Surg 2006; 17:1-5.
17. Kessler I. Cross transposition of short amputation stumps for reconstruction of the thumb. J Hand Surg Br 1985; 10:76-8.
18. Peacock EE Jr. Reconstruction of the hand by the local transfer of composite tissue island flaps. Plast Reconstr Surg Transplant Bull. 1960; 25:298-311
19. Panagiotis G, Stavros I, Konstantinos D, Anastasios C. One-stage thumb lengthening with use of an osteo-cutaneous 2nd metacarpal flap-a case report. Strat Traum Limb Recon 2009;4:135-139.
20. Loda G. The vascular rein technique: A new way for thumb reconstruction. Ann Chir Main Memb Super 1991; 10(3):251-254.
21. Gainor BJ. Osteo-cutaneous Digital Fillet Flap- A Technical Modification. The Journal of Hand Surgery 1985;10(1):79-82.
22. Nathan Patrick, Alexander Payatakes. Vascularized Spare Parts Reconstruction of Hand Gunshot Injury. The Journal of Hand Surgery (Asian-Pacific Volume) 2017;22(3):391-299.
23. Chase RA. The Damaged Index Digit. A Source of Components to Restore the Crippled Hand. The Journal of Bone and Joint Surgery 1968; 50A:1152-1160.
24. Littler JW. The Neurovascular Pedicle Method of Digital Transposition for Reconstruction of the Thumb. Plastic and Reconstructive Surgery 1953; 12: 303-319.
25. Coban YK, Uzel M, Cetinus E. The use of vascularized phalanx for the first metacarpal bone defect in a mutilating hand injury. Case report. Ann Chir Plast Esthet 2006; 51:235-238.
