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Utilizing the Vascularized Semi-Third-Metacarpal Graft for Reconstruction of the Segmental Bone Defects of Proximal Phalanges in 21 Fingers
Xu Zhang, MD1, Yadong Yu, MD2, Xinzhong Shao, MD1, Guisheng Zhang, md2 and Xuchao Luo, md3, (1)Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, China, (2)Third Hospital of Hebei Medical University, Shijiazhuang, China, (3)Second Affiliated Hospital of Southwest Medical University, Luzhou, China

Utilizing the Vascularized Semi-Third-Metacarpal Graft for Reconstruction of the Segmental Bone Defects of Proximal Phalanges in 21 Fingers



Abstract



Introduction: To describe the use of vascularized semi-third-metacarpal graft for reconstruction of large segmental defects of proximal phalanges, which were the results of injuries and osteomyelitis, especially in the hand only one or two fingers were left after injuries.

Materials & Methods: From May 2014 to February 2017, 21 patients who had a large segmental bone defect of the proximal phalanx were treated with the long vascularized bone graft taken from the third metacarpal. The graft was supplied by the reverse-flow of the second or third dorsal metacarpal artery. The causes of the bone defects included osteomyelitis, injuries, and a combination of them. In 19 patients, only one finger was left after the previous injury, and in 2 patients two fingers were left. The fingers included index (n=1), long (n=3), ring (n=16), and little finger (n=1). The mean length of the segmental defects was 3.4 cm (range, 2.5 to 5 cm). The mean length of the bone grafts was 3.1 cm (range, 2.3 to 4.7 cm), and the width was nearly half the third metacarpal bone, but not involved the head and the articular surface of the base of the third metacarpal bone. The nutrient artery penetrating into the base of the third metacarpal was included in the pedicle. After debridement, the vascularized graft was placed in the defect of the proximal phalanx and fixed with a mini plate and screw system. The remaining void was filled with bone grafts taken from the third metacarpal or allogenic bone grafts. The donor site of the third metacarpal bone was filled with allogenic bone grafts.

Results: After surgery, radiographic bone healing was achieved at the mean time of 8 weeks. At the mean final follow-up of 26 months, the mean motion arc of the metacarpal phalangeal joints was 72°, compared to 92° on the opposite side. The mean motion arc of the proximal phalangeal joints was 42°, compared to 87°on the opposite side. According to the Disabilities of the Shoulder, Arm, and Hand, the mean score was 12.

Conclusions: This technique is useful for the preservation of the finger function by reconstruction of the bone defect of the proximal phalanx, especially in hands where only one or two fingers were left after injuries.


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