McFadden J A
Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, USA.
J Reconstr Microsurg. 1998 Jul;14(5):309-12. doi: 10.1055/s-2007-1000182.
The author reports the salvage of the index finger in a patient with extensive osteomyelitis of the proximal phalanx. Salvage was achieved by a staged reconstruction, using external fixation combined with aggressive debridement, and an antibiotic/methylmethacrylate spacer, followed by a vascularized bone flap from the first metatarsal. Union was achieved with an excellent functional outcome of 205 degrees of total active motion. The literature addressing the management of osteomyelitis in this particular location is incomplete. This author believes that loss of a large portion of the diaphysis is difficult to treat by conventional bone grafting because of the poorly vascularized bed following extensive infection. The case reported is unique because of the choice of donor site. Vascularized bone grafting is suggested as offering the best chance for success, and the donor-site material can be easily tailored to fit the phalangeal defects.
作者报告了一例近端指骨广泛骨髓炎患者示指的挽救情况。通过分期重建实现挽救，采用外固定结合积极清创、抗生素/甲基丙烯酸甲酯间隔物，随后取自第一跖骨的带血管骨瓣。实现了骨愈合，总主动活动度达205度，功能结果良好。关于该特定部位骨髓炎治疗的文献并不完整。作者认为，由于广泛感染后骨床血运差，骨干大部分缺失难以通过传统骨移植治疗。所报告的病例因供区选择而独特。建议采用带血管骨移植，因为其成功机会最大，且供区材料可轻松定制以适应指骨缺损。
