Herisson Olivier, Masquelet Alain-Charles, Doursounian Levon, Sautet Alain, Cambon-Binder Adeline
Orthopaedic, Trauma, and Hand Surgery, Saint Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
Université Pierre et Marie Curie Paris 6, 4 place Jussieu, 75005, Paris, France.
Arch Orthop Trauma Surg. 2017 May;137(5):719-723. doi: 10.1007/s00402-017-2666-2. Epub 2017 Mar 13.
Injuries referred to as "rollover hands" are associated with multiple and complex lesions of the dorsal aspect of the hand. We present a case of a multitissular reconstruction following a severe injury of the dorsum of the fingers in a 45-year-old woman.
The bone loss reconstruction was performed in two stages using the Masquelet induced membrane technique. In the first stage, a cement spacer was inserted into the phalanx bone defects. For the second stage, the membrane induced by the foreign-body reaction was opened, the spacer was removed, and an autologous cancellous bone graft was inserted into the defects. The skin coverage was obtained using a reverse ulnar artery forearm pedicled flap. The digits were covered jointly. Three surgical procedures over the course of a 2-month period were required to desyndactylize the fingers and to defat the flap.
At the 2-year follow-up examination, the patient exhibited good integration of their hand use in daily living. The esthetic result was deemed to be satisfactory. Definitive bone consolidation occurred 4 months after the second stage.
Rollover hands are typically a challenge for both the patient and the hand surgeon. The risk of septic complications, as well as the need for several stages of surgical reconstruction, makes the Masquelet technique particularly attractive for the treatment of phalanx bone defects consecutive to rollover injuries.
被称为“翻车手”的损伤与手部背侧的多种复杂损伤有关。我们报告一例45岁女性手指背侧严重损伤后的多组织重建病例。
采用Masquelet诱导膜技术分两阶段进行骨缺损重建。第一阶段，将骨水泥间隔物插入指骨缺损处。第二阶段，打开异物反应诱导的膜，取出间隔物，并将自体松质骨移植到缺损处。采用尺动脉逆行前臂带蒂皮瓣覆盖创面。手指联合覆盖。在2个月的时间里需要进行三次外科手术来使手指分指并对皮瓣进行去脂处理。
在2年的随访检查中，患者在日常生活中手部使用功能恢复良好。美学效果令人满意。第二阶段术后4个月实现了最终的骨愈合。
“翻车手”通常对患者和手外科医生都是一个挑战。感染并发症的风险以及需要进行多个阶段的手术重建，使得Masquelet技术对于治疗翻车伤后连续的指骨缺损特别有吸引力。
