Reconstruction of a phalangeal bone using a vascularised metacarpal bone graft nourished by a dorsal metacarpal artery.
ABSTRACT We report on a patient with an infected nonunion of the left little-finger phalanges following a gunshot injury. The defect was treated by transplanting a partial fifth metacarpus, vascularised by the fourth dorsal metacarpal vessels. Bone union was obtained 6 months after surgery and no signs of infection were found at the site of the nonunion. Although the range of the interphalangeal joints of the finger was limited, the patient was satisfied because the preserved little finger had a metacarpophalangeal (MP) joint with unrestricted motion.
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ABSTRACT: Large segmental defects of long bones comprise a complex pathology resulting from a variety of aetiologies. Their prolonged, painful and uncertain treatment is usually beset with a range of consequences for the patient, varying from the psychological to the socioeconomic. Trauma, osteomyelitis, bone tumour resections or treatment of congenital deformities are main causes of bone deficiency. Their treatment has been thoroughly studied for the last 35 years and both vascularized bone grafting and distraction osteogenesis with the Ilizarov technique have emerged as gold standards. Novel techniques have arisen during the last 10 years, giving new perspectives to the management of this problem. Intramedullary lengthening devices, bioactive membranes, osteogenic proteins and tissue engineering are the new weapons in the armamentarium of orthopaedic surgeons. This study describes the aforementioned treatment techniques (classic and novel) and elaborates on their indications, advantages/disadvantages and complications. Algorithms for the assessment and treatment of critically size long-bone segmental defects are also proposed.Orthopaedics and Trauma. 01/2010; 24(2):149-163.
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ABSTRACT: Reconstruction of complex defects of the distal portion of the foot remains a challenging problem for plastic surgeons. A traumatic case is presented where reconstruction of a complex plantar defect of the hallux was achieved using a distally-based osteocutaneous metatarsal artery flap based on the second dorsal metatarsal artery. Local flap repair is a viable reconstructive option for complex defects of the plantar surface of the forefoot.Journal of Plastic Reconstructive & Aesthetic Surgery 05/2014; · 1.44 Impact Factor
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ABSTRACT: Hand trauma resulting from firearms is becoming more common in civilian life. In the past, as in wartime, infection was a main source of concern following firearm-related hand injuries, whereas in current civilian life with modern medical care, infection rates are actually low for such injuries. As infection is now of a lesser concern, the focus should shift to improve functional outcomes. This review summarizes available literature regarding the management of gunshot wounds to the hand, with particular focus on functional outcomes. In conducting this review, we found that there is not comprehensive information regarding management of gunshot wounds to the hand, and literature discussing functional recovery of the hand is limited. Given the current evidence related to management of gunshot wounds to the hand, we believe that early debridement, antibiotic treatment, reconstruction, and rehabilitation offer patients the best chance for full functional recovery.The Journal of hand surgery 04/2013; · 1.33 Impact Factor