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14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

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Hybrid vascularized bone and soft tissue transfer for massive bone and skin defect of the digit. Surgical Technique and mid-term follow up

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  • presenting/speaker Naohito Hibino - Tokushima Prefecture Naruto Hospital, Tokushima, Japan
  • Yoshitaka Hamada - Tokushima Prefecture Naruto Hospital, Tokushima, Japan
  • Ryosuke Satoh - Tokushima Prefecture Naruto Hospital, Tokushima, Japan
  • Masahiro Yamano - Tokushima Prefecture Naruto Hospital, Tokushima, Japan
  • Tomoya Terai - Tokushima Prefecture Naruto Hospital, Tokushima, Japan
  • Tokio Kasai - Tokushima Prefecture Naruto Hospital, Tokushima, Japan

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1154

doi: 10.3205/19ifssh1047, urn:nbn:de:0183-19ifssh10475

Published: February 6, 2020

© 2020 Hibino et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objectives/Interrogation: Although living bone can be transplanted as a vascularized bone graft for traumatic injuries with massive bone and dorsal skin defects of the digit, it is difficult to work the bone into various fine shapes, especially if the parts required are small and contain joints. Applying a free bone graft raises concerns regarding bone resorption, fracture of the grafted bone, and non-union of the docking site. We hypothesize that a vascularized periosteal flap (VPF) from the medial condyle of the femur [1] can promote the blood flow for free bone molded in fine shaped and provide the bed for the free skin graft. The purpose of this study is to evaluate the VPF promote remodeling of the free bone graft and provide the bed of skin graft in clinical setting.

Methods: We reconstructed a bone defect with inadequate surrounding soft tissue using a free bone graft wrapped with a vascularized corticoperiosteal flap from the medial condyle of the femur. We expected the vascularized periosteum to augment blood flow for the free grafted bone and to provide the bed for the free skin graft. We utilized this procedure in 2 cases of traumatic bone injury with a dorsal skin defect of the digit that occurred in industrial accidents (Figure 1 [Fig. 1]).

Results and Conclusions: The vascularized corticoperiosteal grafts from the femur prevented atrophy and resorption of the free grafted bone, promoted bone remodeling, and provided a less bulky appearance of the skin. This method could be a useful option for reconstructing wide defects of small bone with a poor-quality surrounding environment.

Outline

References

1.
Sakai K, Doi K, Kawai S. Free vascularized thin corticoperiosteal graft. Plast Reconstr Surg. 1991 Feb;87(2):290-8.