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Immediate reconstruction of complex hand trauma with iliac crest bone graft and 2 pedicled fasciocutaneous skin flaps: a case report.

Stahl S, Lotter O, Stahl AS, Schaller HE, Sinis N - Eplasty (2010)

Bottom Line: Length and sensation of the digits were fully preserved while the destroyed joints were fused and covered with mobile soft tissue.Hereby, a satisfactory pinch grip and hand closure was restored, allowing the patient to return to work after only 2 months.Given proper planning and adequate debridement, primary reconstruction of all injured structures should be considered when dealing with complex hand injuries.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Germany. sstahl@bgu-tuebingen.de

ABSTRACT

Objective: The decision about primary or staged reconstruction of all structures in severe hand injuries is controversial. The purpose of this case report is to present a surgical protocol that lead to good functional results and rapid recovery after primary bone grafting with pedicled flap coverage of a complex hand injury.

Methods: A case is reported in which 2 iliac crest bone grafts, an extended dorsal metacarpal artery flap and a heterodigital island flap, were performed at primary intervention to reconstruct the index and middle fingers of a 17-year-old patient.

Results: Length and sensation of the digits were fully preserved while the destroyed joints were fused and covered with mobile soft tissue. Hereby, a satisfactory pinch grip and hand closure was restored, allowing the patient to return to work after only 2 months.

Conclusions: Given proper planning and adequate debridement, primary reconstruction of all injured structures should be considered when dealing with complex hand injuries.

No MeSH data available.


Related in: MedlinePlus

Postoperative functional result at 6 months. Note that a rotational deviation of the third digit remains after arthrodesis of the proximal interphalangeal joint.
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Figure 3: Postoperative functional result at 6 months. Note that a rotational deviation of the third digit remains after arthrodesis of the proximal interphalangeal joint.

Mentions: The patient returned to full-duty status 2 months after surgery. At follow-up examination after 6 months, a good functional result was noted (Fig 3) and the postoperative radiographs showed solid consolidation of the fused joints (Fig 4). The range of motion of all other joints was normal except a 30° extension deficit of the DIP joint of the index finger. Grip strength measurement with the JAMAR dynamometer at position 3 reached 30 kg on the left side and 50 kg on the right side. Key pinch strength averaged 10 kg on the left side and 13 kg on the right side. The patient was free of pain and assured he would request a reconstruction again. DASH (disabilities of the arm, shoulder, and hand) scored 26.66 points.


Immediate reconstruction of complex hand trauma with iliac crest bone graft and 2 pedicled fasciocutaneous skin flaps: a case report.

Stahl S, Lotter O, Stahl AS, Schaller HE, Sinis N - Eplasty (2010)

Postoperative functional result at 6 months. Note that a rotational deviation of the third digit remains after arthrodesis of the proximal interphalangeal joint.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2836851&req=5

Figure 3: Postoperative functional result at 6 months. Note that a rotational deviation of the third digit remains after arthrodesis of the proximal interphalangeal joint.
Mentions: The patient returned to full-duty status 2 months after surgery. At follow-up examination after 6 months, a good functional result was noted (Fig 3) and the postoperative radiographs showed solid consolidation of the fused joints (Fig 4). The range of motion of all other joints was normal except a 30° extension deficit of the DIP joint of the index finger. Grip strength measurement with the JAMAR dynamometer at position 3 reached 30 kg on the left side and 50 kg on the right side. Key pinch strength averaged 10 kg on the left side and 13 kg on the right side. The patient was free of pain and assured he would request a reconstruction again. DASH (disabilities of the arm, shoulder, and hand) scored 26.66 points.

Bottom Line: Length and sensation of the digits were fully preserved while the destroyed joints were fused and covered with mobile soft tissue.Hereby, a satisfactory pinch grip and hand closure was restored, allowing the patient to return to work after only 2 months.Given proper planning and adequate debridement, primary reconstruction of all injured structures should be considered when dealing with complex hand injuries.

View Article: PubMed Central - PubMed

Affiliation: Department of Plastic, Hand and Reconstructive Surgery, Burn Center, BG-Trauma Center, Eberhard-Karl University of Tübingen, Germany. sstahl@bgu-tuebingen.de

ABSTRACT

Objective: The decision about primary or staged reconstruction of all structures in severe hand injuries is controversial. The purpose of this case report is to present a surgical protocol that lead to good functional results and rapid recovery after primary bone grafting with pedicled flap coverage of a complex hand injury.

Methods: A case is reported in which 2 iliac crest bone grafts, an extended dorsal metacarpal artery flap and a heterodigital island flap, were performed at primary intervention to reconstruct the index and middle fingers of a 17-year-old patient.

Results: Length and sensation of the digits were fully preserved while the destroyed joints were fused and covered with mobile soft tissue. Hereby, a satisfactory pinch grip and hand closure was restored, allowing the patient to return to work after only 2 months.

Conclusions: Given proper planning and adequate debridement, primary reconstruction of all injured structures should be considered when dealing with complex hand injuries.

No MeSH data available.


Related in: MedlinePlus