Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report.
Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report.
复制标题
使用与骨替代物相关的诱导膜技术进行手背复杂重建：病例报告。
DOI：
10.1016/j.jpra.2015.08.001
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发表时间：
2015
期刊：
影响因子：
1.4
通讯作者：
Zwetyenga,Narcisse
中科院分区：
文献类型：
--
作者：
Moris,Vivien;Guillier,David;Rizzi,Philippe;DeTaddeo,Alice;Henault,Benoit;Tchurukdichian,Alain;Zwetyenga,Narcisse
手部高能量创伤常引起骨、肌腱、皮肤等组织缺损，有时伴有手指血管离断。骨稳定是第一步，在管理这样的injuries.Materials和methodsA年轻的病人提出复合组织损失的背部，他的右（占主导地位）的手事故后，表面刨。组织缺损包括前4掌骨骨干、肌腱和皮肤，第3指几乎完全截肢。骨固定包括使用骨钉结合骨水泥填充骨缺损。亨特肌腱棒用于肌腱修复和带蒂腹股沟皮瓣（麦格雷戈）被用来实现皮肤coverage.The水泥被替换为自体皮质松质骨移植结合骨膏（Nanostim）3个月后，水泥stabilization.Results11个月后，事故，病人能够返回工作作为一个木匠。受伤的手的捏和抓力量是对侧手的一半，但没有失去敏感性。活动度非常令人满意，Kapandji评分为9分，平均TAM为280°。病人可以写，打开一个瓶子，并不觉得有限的日常activity.Radiographically，骨的3重建掌骨出现consolidated.ConclusionThe诱导膜技术允许重建的小骨缺损的长骨的手在一个两步的程序，第一步发生在紧急情况下的复合组织创伤。
IntroductionHigh-energy trauma of the hand often causes tissue loss involving bone, tendon and skin and is sometimes accompanied by devascularization of digits. Bone stabilization is the first step in the management of such injuries.Materials and methodsA young patient presented composite tissue loss of the dorsum of his right (dominant) hand following an accident with a surface planer. Tissue loss involved the diaphyses of the first 4 metacarpals, tendons and skin with almost complete amputation of the 3rd finger.Bone stabilization comprised osteosynthesis using pins associated with cement to fill the bone defect. Hunter tendon rods were used for tendon repair and a pedicle groin flap (McGregor) was used to achieve skin coverage.The cement was replaced with autologous cortico-cancellous bone graft combined with bone paste (Nanostim) 3 months after the cement stabilization.ResultsEleven months after the accident, the patient was able to return to work as a carpenter. Pinch and Grasp strength in the injured hand were half that in the contralateral hand, but there was no loss of sensitivity. Mobility was very satisfactory with a Kapandji score of 9 and a mean TAM of 280°. The patient can write, open a bottle and does not feel limited for everyday activities.Radiographically, the bone of the 3 reconstructed metacarpals appears consolidated.ConclusionThe induced membrane technique allowed the reconstruction of small bone deficits in the long bones of the hand in a two-step procedure, the first step taking place in an emergency context of composite tissue trauma.