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Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report.

ABSTRACT: INTRODUCTION:High-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 METHODS:A 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. RESULTS:Eleven 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. CONCLUSION:The 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.

SUBMITTER: Moris V

PROVIDER: S-EPMC4827270 | biostudies-literature | 2015 Dec

REPOSITORIES: biostudies-literature

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Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report.

Moris Vivien V Guillier David D Rizzi Philippe P De Taddeo Alice A Henault Benoit B Tchurukdichian Alain A Zwetyenga Narcisse N

JPRAS open 20151201

<h4>Introduction</h4>High-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.<h4>Materials and methods</h4>A 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 ...[more]

PMID: 27077131

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Project description:Background Cross-field endotracheal intubation is typically performed during tracheal anastomosis to maintain single-lung ventilation. To minimize obstruction of the surgical field by the cross-field tube, special equipment such as high-frequency jet ventilation (HFJV) and extracorporeal membrane oxygenation (ECMO) or advanced techniques such as non-intubated ventilation have been proposed. Here, we describe a simple and practical airway management strategy that requires only conventional ventilators and techniques. Our operation is completed under uniportal video-assisted thoracoscopic surgery (VATS). Case Description We report a case of tracheal adenoid cystic carcinoma (ACC) presenting with cough with bloody sputum in a 53-year-old man. Computed tomography (CT) and flexible bronchoscopy revealed an irregular polypoid neoplasm attached to the right wall of the distal trachea, which almost completely blocked the tracheal lumen. To relieve the symptoms, transbronchoscopic resection of the tumor, followed by curative resection via uniportal VATS under general anesthesia was performed. To maintain single-lung ventilation during tracheal reconstruction, we took advantage of a thin suction tube [internal diameter (ID) 3 mm; external diameter (ED) 4 mm], which was connected to a conventional ventilator. Specifically, by introducing the suction tube into the distal left main bronchus through the endotracheal tube and blowing 100% oxygen, we achieved satisfactory oxygenation throughout the anastomotic process; and the blood CO2 partial pressure was also acceptable. The view of the anastomotic site was far less obstructed owing to the small diameter of the suction tube, and the anastomotic process was smooth and accurate. Postoperative recovery was good, and no stenosis of the reconstructed trachea was observed at the 3-month follow-up. Conclusions Our technique proves to be safe and feasible for selected patients with tracheal tumors, and can be a practical choice for medical centers that are not equipped with HFJV or ECMO.

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Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report.

Publications

Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report.

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