del Piñal Francisco, García-Bernal Francisco J, Delgado Julio, Sanmartín Marcos, Regalado Javier, Cagigal Leopoldo
Instituto de Cirugía Plástica y de la Mano, Hospital Mutua Montañesa, Clínica Mompía, Santander, Spain.
J Hand Surg Am. 2006 Sep;31(7):1075-82. doi: 10.1016/j.jhsa.2006.03.021.
Vascularized bone transplants resist infection and allow rapid healing but keeping small bony segments vascularized, as needed for a finger defect, is a challenge. The purpose of this article is to present a cohort of patients with traumatic intercalated compound bony defects in the fingers that were reconstructed by a vascularized toe phalanx (or part of a phalanx) in a single stage.
Eight patients were treated with an intercalary vascularized bone graft that included a part of the proximal phalanx (3 patients), most of the middle phalanx (4 patients), or a portion of each phalanx (1 patient) of a second toe (totaling 9 bone blocks). There was an associated soft-tissue defect in each patient, an infection in 6 patients, and cartilage loss in 4 patients. The toes were pedicled on the proper digital artery (6 patients) or a segment of the first dorsal metatarsal artery (2 patients). A mean length of 12 mm of vascularized bone was transferred. The associated skin island varied from a minimum of 2 x 1 cm to a maximum of 5 x 3 cm. Bleeding from all of the bone surfaces was evidenced once the clamps were released. The homolateral digital nerve and the contralateral neurovascular pedicle of the toe were kept in place. The toe defect was treated by soft-tissue arthroplasty or arthrodesis. No toe was amputated.
Radiologic bony union was evident at 4 to 6 weeks, except in 1 patient with an acute infection whose distal union failed to unite at 6 weeks because the infection recurred. Finger length loss averaged 3 mm. All patients returned to their preoperative occupation.
In this group of patients the toe phalanx reliably maintained its vascularization, allowing us to solve compound osteocutaneous defects in the fingers in a single stage. Donor site morbidity was minimal.
带血管蒂骨移植可抵抗感染并促进快速愈合，但要使手指缺损所需的小骨段保持血管化具有挑战性。本文旨在介绍一组手指创伤性插入复合性骨缺损患者，这些缺损通过带血管蒂的趾骨（或部分趾骨）一期重建。
8例患者接受了节段性带血管蒂骨移植，其中包括第二趾近节趾骨部分（3例）、中节趾骨大部分（4例）或各趾骨部分（1例）（共9个骨块）。每位患者均伴有软组织缺损，6例患者伴有感染，4例患者伴有软骨缺失。趾骨以合适的指动脉为蒂（6例）或第一跖背动脉一段为蒂（2例）。平均移植带血管蒂骨长度为12毫米。相关皮瓣面积最小为2×1厘米，最大为5×3厘米。松开止血钳后，所有骨面均有出血。保留同侧指神经和趾的对侧神经血管蒂。趾缺损采用软组织关节成形术或关节融合术治疗。未行趾截肢术。
除1例急性感染患者外，其余患者在4至6周时影像学显示骨愈合，该急性感染患者因感染复发，6周时远节骨愈合失败。手指长度平均缩短3毫米。所有患者均恢复术前工作。
在这组患者中，趾骨能可靠地维持其血管化，使我们能够一期解决手指复合性骨皮肤缺损问题。供区并发症极少。
