The Masquelet Technique for Thumb Metacarpal Reconstruction Following Trauma: A Case Report (original) (raw)
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Late Reconstruction of Neglected Metacarpal Shaft Defects Due to Gunshot Wound
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2004
We evaluated eight patients after delayed treatment of nine metacarpal bone defects due to gunshot injuries. The mean length of the metacarpal defects was 3 cm and the average time between the gunshot injury and the reconstruction surgery was 10 months. Although all of the patients had been treated with wound irrigation and debridement immediately following injury, no attempt had been made to repair the metacarpal defect or to maintain metacarpal length. As a result, serious shortening had occurred. After the original length of the metacarpal had been restored by distraction of the soft tissues (1 mm/day), a tri-cortical iliac bone graft was inserted into the bone defect. The average follow-up time was 15 months. Clinical and radiological union was established in all cases after an average of 12 weeks. The mean grip strength of the hand and the mean range of motion of the metacarpophalangeal joint increased by 24% and 60%, respectively.
Late reconstruction of a traumatized hand with loss of multiple fingers
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2017
Reconstrução tardia na mão traumatizada com perda de múltiplos dedos Mutilating hand injuries are a challenge to both the hand surgeon and the patient. The surgeon must make decisions ranging from the initial debridement to which fingers and joints will be preserved and the appropriate use of the parts to be removed. Late reconstruction constitutes the second part of this difficult task. The difficulty attributed to the characteristics of each lesion, the large number of treatment possibilities, and the different levels of complexity must be adapted to the personal needs and motivation of each patient. This case report describes a late hand reconstruction with index and middle finger loss, using metacarpophalangeal joint transplantation of the index finger to gain the proximal interphalangeal function of the middle finger.
2013
Amputation at the proximal phalanx or at the metacarpophalangeal joint can be treated by pollicization of a finger, osteoplastic reconstruction, free microvascular transfer of a toe, or distraction lengthening. The best technique to use to treat these cases depends on the place of amputation and the patient's age, sex, occupation and functional demands. In the past 6 years, we treated 4 patients by lengthening the thumb metacarpal ray and adding a mini wraparound flap from the great toe. All the subjects were female with an average age of 22 years. All 4 patients had sustained traumatic amputations: 2 at the metacarpophalangeal joint and 2 at the base of the proximal phalanx. Distraction was completed approximately 65 days after osteotomy, obtaining an average lengthening of 23 mm. To achieve bone consolidation, the lengthener was left in place for 127 days on average. Microsurgical thumb reconstruction was performed around 3 months after consolidation of the osteotomy. There were no failures or cases of postoperative vascular compromise. The average pinch power was 66% of the opposite hand. The static 2-point discrimination of the reconstructed thumb was 8 mm (range, 7-10 mm). All patients reported being satisfied with the treatment, although 1 patient was partially dissatisfied due to the prolonged length of the treatment. Donor site morbidity was minimal. This procedure is mainly chosen by selected patients who refuse standard microsurgical thumb reconstruction because it requires a longer treatment period
Locked intramedullary nailing of metacarpal fractures secondary to gunshot wounds. Author's reply
J Hand Surg Am, 2007
Purpose: To investigate the results of fixation of 10 metacarpal shaft fractures secondary to low-velocity gunshot wounds with locked intramedullary nails. Methods: We reviewed the results of 10 patients with locked intramedullary nailing of the metacarpal for low-velocity gunshot wounds. Autogenous bone grafting was used in 9 of the 10 fractures. The follow-up period averaged 26 months. The parameters evaluated included angulation, rotational alignment, shortening of the digit, postoperative metacarpophalangeal (MCP) range of motion, and time to union. Results: Nine of 10 fractures showed corticocancellous bone autograft incorporation in the midshaft of the metacarpal on radiographs 3 months after surgery; the single fracture without bone grafting did not unite and required an additional procedure with bone grafting to achieve union. The MCP flexion averaged 81°. All MCP joints attained full extension except for 2 that had a 10°extension lag. One metacarpal required an extensor tendon tenolysis and an MCP capsulotomy. No malrotation of the digits was noted and none of the patients developed an infection. The average shortening was 1.2 mm and 1 metacarpal had an angulation of 6°. Conclusions: Locked intramedullary nailing of the metacarpal with autogenous iliac crest bone graft is an effective technique for treating low-velocity gunshot metacarpal fractures associated with bone loss and comminution. The locked implant maintains satisfactory alignment, length, and rotation of the metacarpal until graft incorporation and bone healing
Cases Journal, 2008
This study reports five cases of crush-avulsion injury to the thumb at different levels presented at our plastic and hand surgery unit between 2005 and 2007. All of the patients were male labors with machine injuries to the thumb with non-replantable amputations. Distal phalanx or proximal phalanx, or both, were used as a free cortical bone graft. The amputated part was skeletonized keeping the periosteum attached to the cortical bone of the phalanx fixing it to the stump and covering it by either local flap like dorsal metacarpal flap or regional flaps like the distally based pedicled radial forearm flap and neurovascular island sensate flap or groin flap. The results were functionally and cosmetically good and follow up X rays showed no osteoporotic resorption after one year.
Primary use of the index finger for reconstruction of amputated thumbs
British Journal of Plastic Surgery, 2004
Seven cases of primary reconstruction of traumatic amputation of the thumb using the index finger are reported. In six cases, the reconstruction was done using an injured index finger, while in one case where the amputation of the thumb was through the carpometacarpal joint, an intact index finger was primarily pollicised. This reduces cost of treatment, hospitalisation period and allows earlier rehabilitation without a period of a 'no thumb experience'. We have followed all the patients for a minimum period of 2 years and all of them have excellent functional results. We believe that pollicisation of a normal index finger, if thumb amputation is through the carpometacarpal joint or an injured index finger at the time of initial management of a severely traumatised hand with thumb amputation is an excellent technique for thumb reconstruction.
Innovative Techniques in Bony Reconstruction to Facilitate Hand Salvage
Annals of Plastic Surgery, 2002
Mutilating injuries of the hand and congenital hand anomalies can present challenging reconstructive scenarios for salvage and restoration of function. During a 5-year period from 1993 to 1997, the plastic and reconstructive surgical unit of East Carolina University Medical Center was presented with a series of unique reconstructive challenges as a result of complex hand injuries that resulted in unexpected opportunities for the salvage of distal components. These traumatic injuries were unique in that, although devastating to the hand, they left the opportunity for salvage of distal vascularized and sensate components of the hand. Other unique challenges arose as a result of patients who did not want to pursue alternative reconstructive options such as toe-to-hand transfers or pollicization. These cases are presented to emphasize alternative algorithms to standard hand reconstruction in complex scenarios. Three patients presented with distal viable (vascularized and sensate) phalangeal components with proximal complex bony defects, 1 patient presented with a complex thumb defect and declined standard therapy, and 1 patient presented with a congenital thumb anomaly and declined standard therapy. All flaps survived and all hands were saved. These patients illustrate the clinical feasibility of osteocutaneous and free osseous grafting to provide strut stabilization in metacarpal defects and to preserve an opposable post after thumb amputation or thumb anomaly. Jenkins NL, Lalikos JF, Wooden WA, Benacci JC, Meadows Jr WM. Innovative techniques in bony reconstruction to facilitate hand salvage.