ARTICLE IN PRESS

THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE 200652

11.1 VASCULARIZED BONE BLOCKS FROM THE

TOE PHALANX TO SOLVE COMPLEX INTERCA-

LATED DEFECTS IN THE FINGERS

F. Del Pinal, F. J. Garcıa-Bernal, J. Delgado Martinez,J. Regalado Bilbao, M. Sanmartin Fernandez andL. CagigalInstituto de Cirugıa Plastica y de la Mano, Spain

Background: Whereas large vascularized bone graftshave become a standard procedure in reconstructivesurgery, the use of small bone segments for reconstruc-tion of bone loss in the hand has been sparsely reported.In part, this is due to the fact that keeping small bonysegments vascularized on a pedicle is challenging.Purpose: To present a cohort of patients with anintercalated compound bony defect in fingers who werereconstructed with a vascularized toe phalanx.Patients and methods: Eight patients with a complexbony defect of the finger were treated with anintercalated vascularized bone graft that included a partof the proximal phalanx (three cases), most of themiddle phalanx (four cases), or a portion of eachphalanx (one case) of a second toe (totalling nine boneblocks). There was associated loss of soft tissue in eachcase, which was reconstructed simultaneously with acutaneous flap from the toe. The flaps were pedicled onthe proper digital artery (six cases) or a segment of thefirst dorsal metatarsal artery (two cases). The homo-lateral digital nerve and the contralateral neurovascularpedicle of the toe were kept in place. The toe defect wasresolved by soft-tissue arthroplasty or fusion.Results: A mean length of 12.2mm (range 6–19mm) ofvascularized bone was transferred. Arterial anastomosiswas carried out, in every case, to a proper digital artery end-to-end. Similarly, end-to-end anastomosis of a subcuta-neous vein was performed on the digital web. Bleeding fromall the bone surfaces was observed once the tourniquet wasreleased. Radiological bony union was evident at 4 to 6weeks in all but one patient, who achieved bony union at 10weeks. In every case the skin flaps fully survived.Conclusion: The toe phalanx has reliably maintained itsvascularization after harvesting. We were able to solvecompound osteocutaneous defects in the fingers in asingle stage by transferring vascularized toe phalanges.Donor site morbidity has been minimal.

10.1016/j.jhsb.2006.03.040

11.2 VASCULARIZED MUSCULAR AND MUSCULO-

CUTANEOUS FLAPS AND VASCULARIZED BONE

SEGMENT TRANSFER FOR MANAGEMENT OF

CHRONIC OSTEOMYELITIS

S. GhahremaniIran Medical Science University, Iran

Background: Chronic osteomyelitis though treatedmedically and surgically, recurs within less than 2 yearsbecause of numerous reasons including sequesters,poor blood supply, residual dead space and resistantmicroorganisms. Recovery from this disease essen-tially involves the following treatment approaches: (1)long-term administration of various antibiotics; (2)effective surgery. Antibiotic treatment will not provesuccessful until dead, osseous and soft fibrotic tissueexcision is complete. Meanwhile, wide debridement ofwound and fibrotic tissue excision makes direct closureof tissue unfeasible. Today rotational and free flapprocedures make direct closure of wounds possible oncomplete debridement and removal of soft fibrotictissue.Methods: Our clinical experiences in the recent 10 yearsindicate the success of these techniques in treatment ofupper and lower limb osteomyelitis following removal ofsequesters along with antibiotic therapy. The remark-able effectiveness of vascularized flaps is accounted forincreased blood supply, oxygen and the defensemechanism of the infected area.Discussion: Our experiences indicate that to manageupper limb osteomyelitis, the rotational musculocuta-neous flap followed by vascularized free fibula has beenmore successful. However, for the lower limb, themuscular or musculocutaneous free flap has been moreeffective. The various management and treatment ofchronic osteomyelitis by rotational, island and free flapprocedures will be presented.

10.1016/j.jhsb.2006.03.041