Some Available Vascularized Bone Grafts in Posttraumatic Hand Reconstruction

Very frequent in traumatology, bone defects of the hand raise many reconstructive problems from both tactical and technical points of view First, in cases of isolated bone defects, it is often not possible to shorten the bone segment without functional impairment of the hand. Also, it is not easy to find similar bone for structure and dimension. It is well-known that the majority of fractures with bone defects in the hand are part of complex traumas in which some soft-tissue defects are also present. There is a great advantage offered by vascularized bone grafts. The authors attempted to demonstrate the advantages of using local or regional vascularized bone grafts and also vascularized rib as part of a serratus anterior muscle flap (SARIB).

In 19 patients with bone defects of the hand, the authors have used the following types of procedure: vascularized metacarpal bone as part of a dorsal metacarpal flap in 2 cases; vascularized radial bone as part of a reverse Chinese island flap in 2 cases; vascularized radial bone as part of a distally-based osteofascial perforator flap in 5 cases; vascularized bone segment from a non-replantable finger in 2 cases; vascularized toe joint in 2 cases; vascularized rib(s) segment(s) as part of a serratus anterior muscle flap (SARIB) in 5 cases. The bone defects were located in: the thumb (11), long fingers (2), carpometacarpal region (6). The history of the flaps was uneventful, with consolidation in 6 to 10 weeks and good morphological and functional reintegration.

With small bone defects without soft-tissue defects, the authors believe it is better to use local or regional flaps, including vascularized bone segments. In cases of multidigital amputation including the thumb, the latter can be reconstructed by using a vascularized bone segment from an unreplantable long finger. For defects affecting a finger joint, this seems to be the most reasonable method. The SARIB flap is indicated for solving the problem of large bone defects accompanying complex traumas with large soft-tissue defects.