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Metacarpal Lengthening Using a Mini-Ring Ilizarov Device for Thumb Reconstruction. J Hand Surg Am 2023:S0363-5023(22)00543-3. [PMID: 36925407 DOI: 10.1016/j.jhsa.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 08/20/2022] [Accepted: 09/15/2022] [Indexed: 03/18/2023]
Abstract
PURPOSE To explore the results of using the mini-ring Ilizarov external fixator for thumb metacarpal lengthening and its compatibility with a simultaneous groin flap. METHODS From May 2016 to June 2019, 17 adult patients with thumb loss were treated with metacarpal lengthening using a mini-ring Ilizarov device. The device was composed of 2 rings, threaded rods, nuts, and K-wires (diameter, 1.5 mm). Of these patients, 6 also underwent simultaneous groin flap transfer. Lengthening was started 3 days after surgery at a rate of 0.66 mm/d. The pedicle of the groin flap was divided 1 month after the surgery. The healing index (days per cm), which denotes the number of days the external fixator is attached to the bone per centimeter of length gained, was used to evaluate the lengthening efficiency. RESULTS The patients were observed for 21.9 ± 9.0 months. The lengthening continued for 29.1 ± 4.5 days, resulting in an additional length of 1.9 ± 0.3 cm. CONCLUSIONS The mini-ring Ilizarov external fixator is a simple device for primary metacarpal lengthening. This device can be used with a groin flap for single-stage lengthening of injured thumbs with bone exposure. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Golin AP, Zhang Z, Ratanshi I, McInnes CW. Acute Thumb Reconstruction With Medial Femoral Condyle and Radial Forearm Free Flaps: A Case Report. Hand (N Y) 2022; 18:NP1-NP6. [PMID: 35668636 PMCID: PMC10152520 DOI: 10.1177/15589447221096705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic thumb injuries often result in significant functional disability. With segmental bone loss, reconstructive options include antibiotic cement with delayed bone graft, revision amputation with webspace deepening, metacarpal distraction osteogenesis, index pollicization, bone flap, and free toe transfer. We present a case of a subtotal thumb amputation just distal to the metacarpal phalangeal joint resulting in loss of both soft tissue and a segmental bone defect of the proximal and distal phalanx. Reconstruction was initially performed with a chimeric bone free flap from the medial femoral condyle with a vastus medialis muscle cuff to provide soft tissue coverage. A revision soft tissue coverage procedure was required and a radial forearm free flap was utilized. His reconstruction restored his missing bone and soft tissue, and provided stability with sufficient grip strength and metacarpophalangeal function resulting in a satisfactory functional outcome.
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Affiliation(s)
- Andrew P Golin
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Zach Zhang
- Division of Plastic Surgery, University of British Columbia, Vancouver, Canada
| | - Imran Ratanshi
- Division of Plastic Surgery, University of British Columbia, Vancouver, Canada.,Royal Columbian Hospital, Fraser Health Authority, British Columbia, Canada
| | - Colin W McInnes
- Division of Plastic Surgery, University of British Columbia, Vancouver, Canada.,Royal Columbian Hospital, Fraser Health Authority, British Columbia, Canada
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Fang J, Wang B, Hao R, Wang W, Jia S, Wang B, Gong Z, Zhang Y, Yang H. [Application of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique for thumb defect]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:989-993. [PMID: 34387427 DOI: 10.7507/1002-1892.202101159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique in treatment of thumb defect. Methods Between February 2017 and June 2019, 6 patients with traumatic thumb defects were treated with double osteotomy and lengthening of proximal phalanx and metacarpal by Ilizarov technique. There were 5 males and 1 female. The age ranged from 28 to 57 years, with an average of 41.5 years. There were 3 cases on the left side and 3 cases on the right side. All patients were admitted to the hospital in emergency department after injury, and the stump of the thumb was trimmed and sutured. The osteotomy plane was the distal part of the proximal phalanx in 4 cases and the interphalangeal joint in 2 cases. The interval between injury and osteotomy was 20-245 days (median, 34.5 days). After minimally invasive osteotomy and placement of a semi-circular external fixator, the lengthening began on the 5th day. The proximal phalanx and metacarpal were lengthened by 0.5 mm every day, once every 12 hours. The thumb of the affected side was distracted to the middle of the distal phalanx of the healthy thumb, and the fixator was removed after the bone healed. Results The distraction time was 14-23 days, with an average of 18.8 days. The osteotomies were healed with healing time of 91-147 days (mean, 120.2 days). The total distraction length of the proximal phalanx and metacarpal was 1.40-2.25 cm, with an average of 1.86 cm; healing index was 51.0-72.2 days/cm, with an average of 64.9 days/cm. All patients were followed up 5-12 months (mean, 8.2 months). At last follow-up, the two-point discrimination was 5.3-8.5 mm with an average of 6.98 mm. According to the evaluation standard of the upper limb part of the Chinese Medical Association, the score was 10-14, with an average of 12.5. Among them, 4 cases were excellent and 2 cases were good, with an excellent and good rate of 100%. All patients were satisfied with the function and appearance of thumb after operation. The Quick Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score was 2.3-9.1, with an average of 6.1. Conclusion The double osteotomy and lengthening of proximal phalanx and metacarpal with Ilizarov technique is an effective method for the treatment of thumb defects.
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Affiliation(s)
- Jun Fang
- The First Department of Hand Surgery and Reconstructive Surgery, Tangshan Second Hospital (Affiliated Orthopaedic Hospital, North China University of Science and Technology), Tangshan Hebei, 063000, P.R.China
| | - Bin Wang
- The First Department of Hand Surgery and Reconstructive Surgery, Tangshan Second Hospital (Affiliated Orthopaedic Hospital, North China University of Science and Technology), Tangshan Hebei, 063000, P.R.China
| | - Ruizheng Hao
- The First Department of Hand Surgery and Reconstructive Surgery, Tangshan Second Hospital (Affiliated Orthopaedic Hospital, North China University of Science and Technology), Tangshan Hebei, 063000, P.R.China
| | - Wei Wang
- The First Department of Hand Surgery and Reconstructive Surgery, Tangshan Second Hospital (Affiliated Orthopaedic Hospital, North China University of Science and Technology), Tangshan Hebei, 063000, P.R.China
| | - Song Jia
- The First Department of Hand Surgery and Reconstructive Surgery, Tangshan Second Hospital (Affiliated Orthopaedic Hospital, North China University of Science and Technology), Tangshan Hebei, 063000, P.R.China
| | - Binggang Wang
- The Fifth Department of Trauma Surgery, Tangshan Second Hospital (Affiliated Orthopaedic Hospital, North China University of Science and Technology), Tangshan Hebei, 063000, P.R.China
| | - Zhongping Gong
- The First Department of Hand Surgery and Reconstructive Surgery, Tangshan Second Hospital (Affiliated Orthopaedic Hospital, North China University of Science and Technology), Tangshan Hebei, 063000, P.R.China
| | - Yi Zhang
- Department of Orthopaedics, Affiliated Hospital of North China University of Science and Technology, Tangshan Hebei, 063000, P.R.China
| | - Huanyou Yang
- The First Department of Hand Surgery and Reconstructive Surgery, Tangshan Second Hospital (Affiliated Orthopaedic Hospital, North China University of Science and Technology), Tangshan Hebei, 063000, P.R.China
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Wang B, Wang H, Meng Z, Liu W, Hao R, Zhang J, Huo Y, Chen C, Jia S. [Application of Ilizarov technique in functional reconstruction of thumb degloving injury after amputation]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1545-1548. [PMID: 30569681 DOI: 10.7507/1002-1892.201803047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of Ilizarov technique in reconstruction of thumb function in patients with thumb degloving injury after amputation. Methods Between June 2011 and September 2016, 9 cases of thumb degloving injury were treated with amputation and Ilizarov technology. There were 8 males and 1 female with an age of 18-52 years (mean, 34.7 years). The amputation plane was the level of the metacarpophalangeal joint in 5 cases, the level of the proximal metacarpophalangeal joint in 2 cases, and the level of the base of the proximal phalanx in 2 cases (the length of proximal phalanx was less than 1 cm). After amputation, the affected finger was shorter than the healthy finger by 4.0-7.5 cm, with an average of 5.7 cm. On the fifth day after operation, the semi-loop external fixation extender was applied for extension, which was extended by 0.5 mm per day, and was extended once every 6 hours. Results After bone lengthening surgery, the first web space elevation and contracture occurred in 8 cases. Six of them were treated with the amputation of the inner muscle of the thumb and the "Z" forming technique, postoperative thumb function recovered well; the remaining 2 cases rejected plasty. All 9 patients were followed up 14-47 months, with an average of 33 months. Bone lengthening time was 64-122 days, with an average of 86 days. The lengthening length of bone was 3.0-5.9 cm, with an average of 4.1 cm, and the average lengthening length was 71.9% of the average shortened length. The fixation time of external fixator was 169-342 days, with an average of 231 days. The healing index was 43.2-59.1 days/cm, with an average of 53.4 days/cm. One case showed prolonged mineralization delay and recovered after "accordion" treatment. Bone healing was finally achieved in all patients, with the healing time ranging from 169 to 342 days, with an average of 231 days. No replantation internal fixation and flexion contracture occurred. The two-point discrimination of extended fingertip was similar to that of normal fingertip. The grip strength reached 53%-89% of the healthy side; the kneading force reached 59%-91% of the healthy side. Conclusion The application of Ilizarov technology to extend the thumb metacarpal lengthening is a good method to reconstruction the thumb function after degloving injury.
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Affiliation(s)
- Bin Wang
- Department of Hand Surgery, Repair and Reconstruction Surgery, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000,
| | - Hui Wang
- Department of Hand Surgery, Repair and Reconstruction Surgery, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Zhao Meng
- Department of Orthopedics, Hebei Children's Hospital, Shijiazhuang Hebei, 050000, P.R.China
| | - Wei Liu
- Department of Hand Surgery, Repair and Reconstruction Surgery, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Ruizheng Hao
- Department of Hand Surgery, Repair and Reconstruction Surgery, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Jian Zhang
- Department of Hand Surgery, Repair and Reconstruction Surgery, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Yongxin Huo
- Department of Hand Surgery, Repair and Reconstruction Surgery, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Chao Chen
- Department of Hand Surgery, Repair and Reconstruction Surgery, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
| | - Song Jia
- Department of Hand Surgery, Repair and Reconstruction Surgery, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China
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