Dataset Information

Thumb Reconstruction after Severe Trauma Using the Masquelet Technique and the Foucher Neurovascular Flap.

ABSTRACT: Complex injuries of fingers with bone and soft tissue loss often result in amputation. We present here a case of thumb reconstruction in a severely injured thumb with bone and dorsal soft tissue loss. Primarily a radical debridement of devascularized tissue was performed and a spacer was implanted, to ensure tissue decontamination and induce a Masquelet's bone membrane. After 6 weeks the spacer was replaced with autologous cancellous bone and a pedicled Foucher neurovascular flap was used to augment the soft tissues. Eight months postoperatively the patient showed a great outcome with thumb length preservation, excellent range of motion and aesthetics. This novel technique facilitates finger and especially thumb preservation without the risk of infection. The Masquelet technique can hereby be safely used for reconstruction of finger injuries and the microsurgical flap coverage can be postponed for the secondary procedure, without compromising the bone regeneration.

SUBMITTER: Luttenberger M

PROVIDER: S-EPMC7544277 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Thumb Reconstruction after Severe Trauma Using the Masquelet Technique and the Foucher Neurovascular Flap.

Luttenberger Martin M Taqatqeh Feras F Dragu Adrian A Bota Olimpiu O

Plastic and reconstructive surgery. Global open 20200921 9

Complex injuries of fingers with bone and soft tissue loss often result in amputation. We present here a case of thumb reconstruction in a severely injured thumb with bone and dorsal soft tissue loss. Primarily a radical debridement of devascularized tissue was performed and a spacer was implanted, to ensure tissue decontamination and induce a Masquelet's bone membrane. After 6 weeks the spacer was replaced with autologous cancellous bone and a pedicled Foucher neurovascular flap was used to aug ...[more]

PMID: 33133949

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Project description:BackgroundThe Masquelet-induced-membrane technique is a commonly used method for treating segmental bone defects. However, there are no established clinical standards for management of the induced membrane before grafting.Questions/purposesTwo clinically based theories were tested in a chronic caprine tibial defect model: (1) a textured spacer that increases the induced-membrane surface area will increase bone regeneration; and (2) surgical scraping to remove a thin tissue layer of the inner induced-membrane surface will enhance bone formation.MethodsThirty-two skeletally mature female goats were assigned to four groups: smooth spacer with or without membrane scraping and textured spacer with or without membrane scraping. During an initial surgical procedure (unilateral, left tibia), a defect was created excising bone (5 cm), periosteum (9 cm), and muscle (10 g). Segments initially were stabilized with an intramedullary rod and an antibiotic-impregnated polymethylmethacrylate spacer with a smooth or textured surface. Four weeks later, the spacer was removed and the induced-membrane was either scraped or left intact before bone grafting. Bone formation was assessed using micro-CT (total bone volume in 2.5-cm central defect region) as the primary outcome; radiographs and histologic analysis as secondary outcomes, with the reviewer blinded to the treatment groups of the samples being assessed 12 weeks after grafting. All statistical tests were performed using a linear mixed effects model approach.ResultsMicro-CT analysis showed greater bone formation in defects with scraped induced membrane (mean, 3034.5 mm3; median, 1928.0 mm3; quartile [Q]1-Q3, 273.3-2921.1 mm3) compared with defects with intact induced membrane (mean, 1709.5 mm3; median, 473.8 mm3; Q1-Q3, 132.2-1272.3 mm3; p = 0.034). There was no difference in bone formation between textured spacers (mean, 2405.5 mm3; median, 772.7 mm3; Q1-Q3, 195.9-2743.8 mm3) and smooth spacers (mean, 2473.2 mm3; median, 1143.6 mm3; Q1-Q3, 230.2-451.1 mm3; p = 0.917).ConclusionsScraping the induced-membrane surface to remove the innermost layer of the induced-membrane increased bone regeneration. A textured spacer that increased the induced-membrane surface area had no effect on bone regeneration.Clinical relevanceScraping the induced membrane during the second stage of the Masquelet technique may be a rapid and simple means of improving healing of segmental bone defects, which needs to be confirmed clinically.

Dataset Information

Thumb Reconstruction after Severe Trauma Using the Masquelet Technique and the Foucher Neurovascular Flap.

Publications

Thumb Reconstruction after Severe Trauma Using the Masquelet Technique and the Foucher Neurovascular Flap.

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