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Metatarsal reconstruction with a fibular osteocutaneous flap: a novel approach utilizing virtual surgical planning.

St Hilaire H, Steele TN, Delatte S, Hebert CK, Canizares O - Plast Reconstr Surg Glob Open (2014)

Bottom Line: A template of the reconstructed bone was designed based on the virtual mirror-image, noninjured bone.Prefabricated cutting guides facilitated precise shaping of the vascularized bone accounting for location of perforators.We believe that VSP can be a valuable tool in reconstruction of metatarsal bones by facilitating precise intraoperative shaping and anatomic orientation of the vascularized flap and reducing flap ischemia and operative time.

View Article: PubMed Central - PubMed

Affiliation: LSU Division of Plastic and Reconstructive Surgery, New Orleans, La.; Private Practice, Lafayette, La.; and Tulane University Division of Plastic & Reconstructive Surgery, New Orleans, La.

ABSTRACT

Summary: Craniofacial reconstruction remains the main application for virtual surgical planning (VSP). We present a case in which this technology was applied to reconstruct a bony defect of the first metatarsal bone from a gunshot injury. VSP was used to facilitate a 1-stage reconstruction with a fibular osteocutaneous flap. A template of the reconstructed bone was designed based on the virtual mirror-image, noninjured bone. Prefabricated cutting guides facilitated precise shaping of the vascularized bone accounting for location of perforators. Successful reconstruction of the metatarsal bone was achieved with excellent functional outcomes. We believe that VSP can be a valuable tool in reconstruction of metatarsal bones by facilitating precise intraoperative shaping and anatomic orientation of the vascularized flap and reducing flap ischemia and operative time.

No MeSH data available.


Related in: MedlinePlus

The fibula osteocutaneous flap was virtually inset into the proximal segment of the injured bone and rotated to position the posterior/medial fibular surface and associated vessels toward the medial side of the foot to accommodate a dorsal plate.
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Figure 2: The fibula osteocutaneous flap was virtually inset into the proximal segment of the injured bone and rotated to position the posterior/medial fibular surface and associated vessels toward the medial side of the foot to accommodate a dorsal plate.

Mentions: A 32-year-old man presented to clinic 6 weeks following an accidental self-inflicted gunshot wound to the medial aspect of the right foot. He suffered a comminuted fracture to the right distal first metatarsal bone with a significant bony defect (Fig. 1) (Supplemental Digital Content 1, http://links.lww.com/PRSGO/A61). A free fibular osteocutaneous flap was planned to reconstruct the injured bone. Appropriate computed tomographic scans of bilateral lower extremities were obtained. Virtual surgical planning (VSP) using VSP Reconstruction software (Medical Modeling Inc., Golden, Colo.) was then undertaken by the reconstructive surgeon. The patient’s preinjury metatarsal bone anatomy was restored virtually using the mirror-imaged contralateral foot. The fibular osteocutaneous flap was also virtually inset into the proximal segment of the injured bone and rotated to position the posterior/medial fibular surface and associated vessels toward the medial side of the foot to accommodate the dorsal plate (Fig. 2). Cutting guides were also developed for both the donor and recipient sites.


Metatarsal reconstruction with a fibular osteocutaneous flap: a novel approach utilizing virtual surgical planning.

St Hilaire H, Steele TN, Delatte S, Hebert CK, Canizares O - Plast Reconstr Surg Glob Open (2014)

The fibula osteocutaneous flap was virtually inset into the proximal segment of the injured bone and rotated to position the posterior/medial fibular surface and associated vessels toward the medial side of the foot to accommodate a dorsal plate.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4255901&req=5

Figure 2: The fibula osteocutaneous flap was virtually inset into the proximal segment of the injured bone and rotated to position the posterior/medial fibular surface and associated vessels toward the medial side of the foot to accommodate a dorsal plate.
Mentions: A 32-year-old man presented to clinic 6 weeks following an accidental self-inflicted gunshot wound to the medial aspect of the right foot. He suffered a comminuted fracture to the right distal first metatarsal bone with a significant bony defect (Fig. 1) (Supplemental Digital Content 1, http://links.lww.com/PRSGO/A61). A free fibular osteocutaneous flap was planned to reconstruct the injured bone. Appropriate computed tomographic scans of bilateral lower extremities were obtained. Virtual surgical planning (VSP) using VSP Reconstruction software (Medical Modeling Inc., Golden, Colo.) was then undertaken by the reconstructive surgeon. The patient’s preinjury metatarsal bone anatomy was restored virtually using the mirror-imaged contralateral foot. The fibular osteocutaneous flap was also virtually inset into the proximal segment of the injured bone and rotated to position the posterior/medial fibular surface and associated vessels toward the medial side of the foot to accommodate the dorsal plate (Fig. 2). Cutting guides were also developed for both the donor and recipient sites.

Bottom Line: A template of the reconstructed bone was designed based on the virtual mirror-image, noninjured bone.Prefabricated cutting guides facilitated precise shaping of the vascularized bone accounting for location of perforators.We believe that VSP can be a valuable tool in reconstruction of metatarsal bones by facilitating precise intraoperative shaping and anatomic orientation of the vascularized flap and reducing flap ischemia and operative time.

View Article: PubMed Central - PubMed

Affiliation: LSU Division of Plastic and Reconstructive Surgery, New Orleans, La.; Private Practice, Lafayette, La.; and Tulane University Division of Plastic & Reconstructive Surgery, New Orleans, La.

ABSTRACT

Summary: Craniofacial reconstruction remains the main application for virtual surgical planning (VSP). We present a case in which this technology was applied to reconstruct a bony defect of the first metatarsal bone from a gunshot injury. VSP was used to facilitate a 1-stage reconstruction with a fibular osteocutaneous flap. A template of the reconstructed bone was designed based on the virtual mirror-image, noninjured bone. Prefabricated cutting guides facilitated precise shaping of the vascularized bone accounting for location of perforators. Successful reconstruction of the metatarsal bone was achieved with excellent functional outcomes. We believe that VSP can be a valuable tool in reconstruction of metatarsal bones by facilitating precise intraoperative shaping and anatomic orientation of the vascularized flap and reducing flap ischemia and operative time.

No MeSH data available.


Related in: MedlinePlus