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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

Prefabricated dorsal plate and plastic fibula template in position.
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Figure 3: Prefabricated dorsal plate and plastic fibula template in position.

Mentions: Intraoperatively, the prefabricated cutting guide facilitated the preparation of the metatarsal bone recipient site and allowed precise osteotomy of the residual distal bone (Supplemental Digital Content 2, http://links.lww.com/PRSGO/A62). A prefabricated surgical plate and plastic fibula template was fitted into the resulting defect in preparation for the fibula flap (Fig. 3). A fibular osteocutaneous flap was then raised from the contralateral leg with a skin paddle measuring 17 cm × 4 cm. Prefabricated cutting guides were placed on the fibula to facilitate the osteotomies with the exact dimensions of the metatarsal bony defect (Supplemental Digital Content 3, http://links.lww.com/PRSGO/A63). Prefabricated dorsal plate was used for fixation of the flap to the proximal phalanx and base of the metatarsal bone. Microsurgical anastomosis of the peroneal artery and vein to the anterior tibial artery and a branch of the greater saphenous, respectively, was performed. The skin paddle was then inset on the dorsum of the foot and closed over a penrose drain. The patient tolerated the procedure well and was discharged postoperative day 3. Three-month follow-up demonstrates restoration of function and stability of the right foot (Fig. 4).


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)

Prefabricated dorsal plate and plastic fibula template in position.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 3: Prefabricated dorsal plate and plastic fibula template in position.
Mentions: Intraoperatively, the prefabricated cutting guide facilitated the preparation of the metatarsal bone recipient site and allowed precise osteotomy of the residual distal bone (Supplemental Digital Content 2, http://links.lww.com/PRSGO/A62). A prefabricated surgical plate and plastic fibula template was fitted into the resulting defect in preparation for the fibula flap (Fig. 3). A fibular osteocutaneous flap was then raised from the contralateral leg with a skin paddle measuring 17 cm × 4 cm. Prefabricated cutting guides were placed on the fibula to facilitate the osteotomies with the exact dimensions of the metatarsal bony defect (Supplemental Digital Content 3, http://links.lww.com/PRSGO/A63). Prefabricated dorsal plate was used for fixation of the flap to the proximal phalanx and base of the metatarsal bone. Microsurgical anastomosis of the peroneal artery and vein to the anterior tibial artery and a branch of the greater saphenous, respectively, was performed. The skin paddle was then inset on the dorsum of the foot and closed over a penrose drain. The patient tolerated the procedure well and was discharged postoperative day 3. Three-month follow-up demonstrates restoration of function and stability of the right foot (Fig. 4).

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