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Boretto JG, Holc F, Victorica PB. The Foot as a Donor Site for Reconstruction in the Hand. Hand Clin 2024; 40:249-258. [PMID: 38553096 DOI: 10.1016/j.hcl.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The foot contains a unique collection of tissue types that can be used in the reconstruction of the hand. Numerous reconstructive options have been presented, some of which have been adopted, such as modifications to procedures that have been described in the past or even newly developed options for hand reconstruction. It is possible to reconstruct missing fingers and other hand structures using tissues taken from the foot rather than removing healthy tissue from a hand that has already been injured. This makes it possible to avoid having healthy tissue removed from an injured hand.
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Affiliation(s)
- Jorge G Boretto
- Hand and Upper Extremity Surgery Department, Prof. Dr. "Carlos Ottolenghi Institute", Hospital Italiano de Buenos Aires.
| | - Fernando Holc
- Hand and Upper Extremity Surgery Department, Prof. Dr. "Carlos Ottolenghi Institute", Hospital Italiano de Buenos Aires
| | - Pedro Bronenberg Victorica
- Hand and Upper Extremity Surgery Department, Prof. Dr. "Carlos Ottolenghi Institute", Hospital Italiano de Buenos Aires
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Xue Y, Yin Y, Yang C, Wang S, Huo Y. Clinical application of a free flap supplied by the osteocutaneous branch of the anterior interosseous artery. HAND SURGERY & REHABILITATION 2024; 43:101679. [PMID: 38428636 DOI: 10.1016/j.hansur.2024.101679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES To explore the clinical application and efficacy of transplantation of free composite flaps supplied by radial osteocutaneous branch of the dorsal branch of the anterior interosseous artery for reconstructing bone and skin defects in the hand. MATERIAL AND METHODS Anatomically, the radial osteocutaneous branch of the dorsal branch of the anterior interosseous artery has constant collateral anastomoses which can provide a large dorsoradial flap from the dorsum of the forearm. This flap was used for reconstruction in five cases of cutaneous and phalangeal defects. RESULTS Reconstruction was successful in all five cases, with consolidated phalanx and good cosmetic results. All donor sites could be closed directly. CONCLUSION Reconstruction with dorsoradial forearm flaps is a reliable procedure which causes minimal trauma. Thus, it is an ideal approach for repairing cutaneous and phalangeal defects.
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Affiliation(s)
- Yunhao Xue
- Department of Hand Surgery, Beijing Jishuitan Hospital, No 31, Xin Jie Kou East Street, Xicheng District, Beijing, 100035, PR China.
| | - Yaobin Yin
- Department of Hand Surgery, Beijing Jishuitan Hospital, No 31, Xin Jie Kou East Street, Xicheng District, Beijing, 100035, PR China
| | - Chen Yang
- Department of Hand Surgery, Beijing Jishuitan Hospital, No 31, Xin Jie Kou East Street, Xicheng District, Beijing, 100035, PR China
| | - Shufeng Wang
- Department of Hand Surgery, Beijing Jishuitan Hospital, No 31, Xin Jie Kou East Street, Xicheng District, Beijing, 100035, PR China
| | - Yongxin Huo
- Department of Hand Surgery, The Second Hospital of Tangshan, No 21, Jianshe Road, Tangshan City, Hebei Province, 063000, PR China
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Woussen E, Aouzal Z, Pluvy I, Fageot J, Feuvrier D, Berthier F, Bouteille C, Woussen A, Obert L, Loisel F. Hand and wrist Osteo-articular bone defect: induced membrane technique indications. HAND SURGERY & REHABILITATION 2023; 42:160-167. [PMID: 36682537 DOI: 10.1016/j.hansur.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 01/08/2023] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
Bone defect in the hand and wrist is the result of 3 main causes: traumatic, infectious or tumoral. Whatever the cause and possibility of emergency management, the site (hand or wrist) and anatomical location (articular or diaphyseal) guide the choice of surgical technique and timing. Functional sequelae do not vary, and the ultimate objective is not so much to fill a defect but to give a useful and accepted finger, hand or wrist.
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Affiliation(s)
- E Woussen
- Service de Chirurgie Orthopédique, Traumatologique, Chirurgie Plastique et Reconstructrice - Assistance Main CHRU bd Fleming 25000 BESANCON, Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, France.
| | - Z Aouzal
- Service de Chirurgie Orthopédique, Traumatologique, Chirurgie Plastique et Reconstructrice - Assistance Main CHRU bd Fleming 25000 BESANCON, Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, France.
| | - I Pluvy
- Service de Chirurgie Orthopédique, Traumatologique, Chirurgie Plastique et Reconstructrice - Assistance Main CHRU bd Fleming 25000 BESANCON, Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, France
| | - J Fageot
- Service de Chirurgie Orthopédique, Traumatologique, Chirurgie Plastique et Reconstructrice - Assistance Main CHRU bd Fleming 25000 BESANCON, Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, France
| | - D Feuvrier
- Service de Chirurgie Orthopédique, Traumatologique, Chirurgie Plastique et Reconstructrice - Assistance Main CHRU bd Fleming 25000 BESANCON, Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, France
| | - F Berthier
- Service d'Anesthésie réanimation, CHRU Besançon, France
| | - C Bouteille
- Service de Chirurgie Orthopédique, Traumatologique, Chirurgie Plastique et Reconstructrice - Assistance Main CHRU bd Fleming 25000 BESANCON, Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, France
| | - A Woussen
- Service de Chirurgie Orthopédique, Traumatologique, Chirurgie Plastique et Reconstructrice - Assistance Main CHRU bd Fleming 25000 BESANCON, Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, France
| | - L Obert
- Service de Chirurgie Orthopédique, Traumatologique, Chirurgie Plastique et Reconstructrice - Assistance Main CHRU bd Fleming 25000 BESANCON, Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, France
| | - F Loisel
- Service de Chirurgie Orthopédique, Traumatologique, Chirurgie Plastique et Reconstructrice - Assistance Main CHRU bd Fleming 25000 BESANCON, Laboratoire de Nanomédecine, Imagerie et Thérapeutique EA4662, Université Bourgogne Franche-Comté, France
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4
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Wang J, Lu H, Xue M, Qiang L, Zhou X. Clinical application of dorsal digital cutaneous branch flap with partial extensor tendon in repairing compound tissue defects of the dorsal finger. J Orthop Surg (Hong Kong) 2022; 29:23094990211054624. [PMID: 34910593 DOI: 10.1177/23094990211054624] [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: 11/15/2022] Open
Abstract
Purpose: To investigate the clinical efficacy of using dorsal digital cutaneous branch flap with partial extensor tendon in repairing compound tissue defects of the dorsal digits of the hand. Methods: Between January 2018 and January 2020, ten patients with skin and soft tissue defects of the digits accompanied by extensor tendon defects underwent surgical repair using dorsal digital cutaneous branch flap with partial extensor tendon. The donor site was repaired with dorsal metacarpal artery flap. The smallest skin defect area was 2.0 × 1.5 cm, while the largest skin defect area was 4.0 × 3.0 cm. The length of tendon defect ranged from 1.5 to 3.0 cm. Sensation within the flap, aesthetic appearance of both the donor and recipient sites, functional recovery, and return-to-work time were measured. Results: All 10 flaps survived after surgery. All patients were followed up for 12-18 months, with an average follow-up period of 15.4 months. After flap repair, the digits had satisfactory shape and appearance along with a soft texture. Hand function was excellent in eight cases and good in two cases. Two-point discrimination was 6-9 mm with an average of 8 mm. No patient experience cold intolerance. The donor sites healed well with satisfactory appearance. Conclusion: Dorsal digital cutaneous branch flap with partial extensor tendon could be used to repair skin and tendon defects simultaneously. The advantages of this method include simple donor tissue harvesting; less donor-site morbidity; reliable blood supply; and satisfactory recovery of appearance, sensation, and function of the flap. Therefore, this method could be suitable for repairing soft tissue defects of the dorsal digits with extensor tendon defects.
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Affiliation(s)
- Jin Wang
- Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, 74735Wuxi Hand Surgery Hospital, Wuxi, Jiangsu, China
| | - Hao Lu
- Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, 74735Wuxi Hand Surgery Hospital, Wuxi, Jiangsu, China
| | - Mingyu Xue
- Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, 74735Wuxi Hand Surgery Hospital, Wuxi, Jiangsu, China
| | - Li Qiang
- Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, 74735Wuxi Hand Surgery Hospital, Wuxi, Jiangsu, China
| | - Xiao Zhou
- Department of Hand Surgery, Wuxi NO.9 People's Hospital Affiliated to Soochow University, 74735Wuxi Hand Surgery Hospital, Wuxi, Jiangsu, China
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Sabapathy SR, Del Piñal F, Boyer MI, Lee DC, Sebastin SJ, Venkatramani H. Management of a mutilated hand: the current trends. J Hand Surg Eur Vol 2022; 47:98-104. [PMID: 34632847 DOI: 10.1177/17531934211047760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Mutilated upper limbs suffer loss of substance of various tissues with loss of prehension. The most important factor in salvage of a mutilated hand is involvement of a senior surgeon at the time of initial assessment and debridement. A regional block given on arrival helps through assessment and investigations in a pain-free state. Infection still remains the important negative determinant to outcome and is prevented by emergent radical debridement and early soft tissue cover. Radical debridement and secure skeletal stabilization must be achieved on day one in all situations. Dermal substitutes and negative pressure wound therapy are increasingly used but have not substituted regular soft tissue cover techniques. Ability to perform secondary procedures and the increased use of the reconstructed hand with time keeps reconstruction a better option than prosthesis fitting. Toe transfers and free functioning muscle transfers are the two major secondary procedures that have influenced outcomes.
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Affiliation(s)
- S Raja Sabapathy
- Department of Plastic, Hand and Microsurgery and Burns, Ganga Hospital, Coimbatore, India
| | | | - Martin I Boyer
- Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA
| | - Dong Chul Lee
- Plastic and Reconstructive Surgery and Hand Surgery, Gwangmyeong Sungae General Hospital, Gyeonggi-do, Republic of Korea
| | | | - Hari Venkatramani
- Department of Plastic, Hand and Microsurgery and Burns, Ganga Hospital, Coimbatore, India
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Agarwal P, Sharma D. Management of Giant Cell Tumour of Hand and Feet with Special Reference to Reconstruction. Indian J Surg 2021. [DOI: 10.1007/s12262-021-03161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Pederson WC, Killion E, White L. Reconstruction of a Portion of the Articular Surface of the Distal Radius With a Vascularized Osteochondral Graft From the Proximal Phalanx of the Great Toe. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:218-223. [PMID: 35415553 PMCID: PMC8991544 DOI: 10.1016/j.jhsg.2021.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/01/2021] [Indexed: 11/08/2022] Open
Abstract
Distal radius fractures are among the most common injuries to the upper extremity and have a bimodal distribution in younger male patients and older women. Young men suffer from high-energy injuries and older women from fragility fractures. Approximately 50% of these are intra-articular. Timely and appropriate treatment usually will lead to an acceptable outcome, but loss of congruity of the articular surface remains a difficult problem to manage. We report here on the case of a 16-year-old boy with malunion of the radial articular surface with lack of motion and pain. He was managed by replacing the displaced and damaged segment of the radial articular surface with a vascularized osteochondral graft from the proximal phalanx of the great toe. This matched the shape of this portion of the radius quite well, and he has had improvements in motion and pain in the 10 months since that time. The donor site has not caused him any difficulty to date.
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Abstract
The main goals of treating severe crush injuries are debriding away devitalized tissue and filling any resultant dead space with vascularized tissue. In the authors' experience, the most ideal methods for soft tissue coverage in treating crush injuries are the iliac flap, the adipofascial lateral arm flap, and the gracilis flap. Accompanying bone defects respond very well to free corticoperiosteal flaps. Digital defects often require the use of complete or subtotal toe transfer to avoid amputation and restore function to the hand.
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Kumta S, Warrier S, Jain L, Ummal R, Menezes M, Purohit S. Medial femoral condyle vascularised corticoperiosteal graft: A suitable choice for scaphoid non-union. Indian J Plast Surg 2019; 50:138-147. [PMID: 29343888 PMCID: PMC5770926 DOI: 10.4103/ijps.ijps_62_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction Scaphoid fractures are not very common and frequently remain undiagnosed, presenting in non-union and persistent wrist pain. Options for scaphoid fracture treatment have been described over several decades, however, none with an optimal solution to achieve union along with good hand function. We describe here, the use of vascularised corticoperiosteal bone grafts from the medial femoral condyle (MFC) as a solution for the difficult problem of scaphoid fracture non-union. Materials and Methods This series has 11 patients with non-union following a scaphoid fracture treated over 18 months ranging from January 2014 to January 2016 using a vascularised corticoperiosteal graft from the MFC. Bone graft fixation was done using K-wires and anastomosis was done with the radial vessels. Results There were no cases of flap loss. Time of union was an average 3 months. All patients had a full range of movements. Discussion MFC is an ideal site for harvesting vascularised corticoperiosteal grafts providing a large surface of tissue supplied by a rich periosteal plexus from the descending genicular artery. No significant donor site morbidities have been reported in any series in the past. The well-defined anatomy helps in a rather simple dissection. Corticoperiosteal grafts have a high osteogenic potential and hence, this vascularised graft seems ideal for small bone non-unions. Conclusion Thin, pliable and highly vascularised corticocancellous grafts can be obtained from the MFC as an optimal treatment option for scaphoid non-unions.
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Affiliation(s)
- Samir Kumta
- Department of Plastic and Reconstructive Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Sudhir Warrier
- Department of Orthopaedic and Hand Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Leena Jain
- Department of Plastic and Reconstructive Surgery, S. L. Raheja - Fortis Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rani Ummal
- Department of Plastic and Reconstructive Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Manik Menezes
- Department of Plastic and Reconstructive Surgery, International Modern Hospital, Dubai, UAE
| | - Shrirang Purohit
- Department of Plastic and Reconstructive Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
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Boretto JG, Fernandez-Fernandez D, Gallucci G, De Carli P. The Fourth Extensor Compartment Artery Vascularized Bone Graft of the Distal Radius for CMC Fusion in the Treatment of Carpal Boss: A Case Report. Hand (N Y) 2017; 12:NP88-NP91. [PMID: 28832203 PMCID: PMC5684924 DOI: 10.1177/1558944716672203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carpometacarpal joints can be affected by traumatic or degenerative pathology. Although different techniques have been described to treat these conditions, most authors agree that arthrodesis is an effective treatment modality. Vascularized bone grafts of the distal radius have been used to treat carpal conditions, such as scaphoid nonunion or Kiënbock disease, and they have been shown to have several advantages over nonvascularized bone grafts. METHODS We report a case of a carpal boss in a female patient treated with an arthrodesis of the second and third carpometacarpal joints by using the fourth extensor compartment artery vascularized bone graft. RESULTS At 6 weeks postoperative bone union was achieved. At 2 years follow-up the patient was able to perform daily life activities without pain. CONCLUSIONS The fourth ECA VBG with reverse blood flow from the dorsal intercarpal arch allowed the graft to reach the CMC. A solid fusion was obtained at 6 weeks due to the biological advantage of the VBG.
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Affiliation(s)
- Jorge G. Boretto
- Hospital Italiano de Buenos Aires, Argentina,Jorge G. Boretto, Hand and Upper Extremity Surgery Department, Prof. Dr. Carlos Ottolenghi Institute, Orthopaedic and Traumatology Service, Hospital Italiano de Buenos Aires, Potosí 4247, Ciudad Autónoma de Buenos Aires C1199ACK, Argentina.
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Herisson O, Masquelet AC, Doursounian L, Sautet A, Cambon-Binder A. Finger reconstruction using induced membrane technique and ulnar pedicled forearm flap: a case report. Arch Orthop Trauma Surg 2017; 137:719-723. [PMID: 28289889 DOI: 10.1007/s00402-017-2666-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Injuries referred to as "rollover hands" are associated with multiple and complex lesions of the dorsal aspect of the hand. We present a case of a multitissular reconstruction following a severe injury of the dorsum of the fingers in a 45-year-old woman. MATERIALS AND METHODS The bone loss reconstruction was performed in two stages using the Masquelet induced membrane technique. In the first stage, a cement spacer was inserted into the phalanx bone defects. For the second stage, the membrane induced by the foreign-body reaction was opened, the spacer was removed, and an autologous cancellous bone graft was inserted into the defects. The skin coverage was obtained using a reverse ulnar artery forearm pedicled flap. The digits were covered jointly. Three surgical procedures over the course of a 2-month period were required to desyndactylize the fingers and to defat the flap. RESULTS At the 2-year follow-up examination, the patient exhibited good integration of their hand use in daily living. The esthetic result was deemed to be satisfactory. Definitive bone consolidation occurred 4 months after the second stage. CONCLUSIONS Rollover hands are typically a challenge for both the patient and the hand surgeon. The risk of septic complications, as well as the need for several stages of surgical reconstruction, makes the Masquelet technique particularly attractive for the treatment of phalanx bone defects consecutive to rollover injuries.
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Affiliation(s)
- Olivier Herisson
- Orthopaedic, Trauma, and Hand Surgery, Saint Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Alain-Charles Masquelet
- Orthopaedic, Trauma, and Hand Surgery, Saint Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
- Université Pierre et Marie Curie Paris 6, 4 place Jussieu, 75005, Paris, France
| | - Levon Doursounian
- Orthopaedic, Trauma, and Hand Surgery, Saint Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
- Université Pierre et Marie Curie Paris 6, 4 place Jussieu, 75005, Paris, France
| | - Alain Sautet
- Orthopaedic, Trauma, and Hand Surgery, Saint Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
- Université Pierre et Marie Curie Paris 6, 4 place Jussieu, 75005, Paris, France
| | - Adeline Cambon-Binder
- Orthopaedic, Trauma, and Hand Surgery, Saint Antoine Hospital, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France.
- Université Pierre et Marie Curie Paris 6, 4 place Jussieu, 75005, Paris, France.
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Del Piñal F, Urrutia E, Klich M. Severe Crush Injury to the Forearm and Hand: The Role of Microsurgery. Clin Plast Surg 2017; 44:233-255. [PMID: 28340660 DOI: 10.1016/j.cps.2016.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The main goals of treating severe crush injuries are debriding away devitalized tissue and filling any resultant dead space with vascularized tissue. In the authors' experience, the most ideal methods for soft tissue coverage in treating crush injuries are the iliac flap, the adipofascial lateral arm flap, and the gracilis flap. Accompanying bone defects respond very well to free corticoperiosteal flaps. Digital defects often require the use of complete or subtotal toe transfer to avoid amputation and restore function to the hand.
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Affiliation(s)
- Francisco Del Piñal
- Instituto de Cirugía Plástica y de la Mano, Private Practice, Hospital La Luz and Hospital Mutua Montañesa, Madrid/Santander, Spain.
| | - Esteban Urrutia
- Instituto de Cirugía Plástica y de la Mano, Private Practice, Hospital La Luz and Hospital Mutua Montañesa, Madrid/Santander, Spain; Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Maciej Klich
- Instituto de Cirugía Plástica y de la Mano, Private Practice, Hospital La Luz and Hospital Mutua Montañesa, Madrid/Santander, Spain; Department of Traumatology and Orthopedics, Clinical Hospital, Warsaw, Otwock, Poland
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Abstract
The thumb should be preserved at all costs, and major efforts to preserve it are justified. If nothing can be done (or desperate measures fail), classic procedures or a toe-to-hand are indicated. This article will not only discuss some tips to succeed in extreme acute scenarios, but will also consider the indications of other alternatives in the acute or subacute setting.
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Affiliation(s)
- Francisco Del Piñal
- Instituto de Cirugía Plástica y de la Mano, Hospital La Luz, Madrid, Spain; Instituto de Cirugía Plástica y de la Mano, Hospital Mutua Montañesa, Santander, Spain.
| | - Davide Pennazzato
- Orthopaedics and Traumatology, Department of Biotechnology and Life Sciences (DBSV), University of Insubria, Varese, Italy
| | - Esteban Urrutia
- Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
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Moris V, Loisel F, Cheval D, See LA, Tchurukdichian A, Pluvy I, Gindraux F, Pauchot J, Zwetyenga N, Obert L. Functional and radiographic evaluation of the treatment of traumatic bone loss of the hand using the Masquelet technique. HAND SURGERY & REHABILITATION 2016; 35:114-21. [PMID: 27117125 DOI: 10.1016/j.hansur.2015.11.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 11/16/2022]
Abstract
This study was a retrospective evaluation of 18 patients with traumatic bone loss affecting the fingers, hand and wrist who were treated using the induced-membrane technique. Sixteen men and two women, mean age 54years (27-74) presented a hand injury including bone loss. Sixteen patients were treated on an emergency basis and two following nonunion of their fractures. There were 13 cases of open fracture of the phalanx and 5 cases of metacarpal fractures. These patients were treated with debridement and the injuries were covered when necessary. To address the bone loss, the first step of the induced-membrane technique involved placing a cement spacer (polymethylmethacrylate [PMMA]) without antibiotics in the defect. During the second step, the cement spacer was removed and replaced by autologous cancellous bone graft. The graft was placed within the biological tube left empty after removal of the cement. For each patient, bone union was assessed with radiographs and/or CT scan. Failure was defined as nonunion at 1year. In 16 patients, the fractures had healed after 4months (1.5-12months) on average. Two failures were noted (one nonunion treated using a PIP prosthesis and one case of delayed union). Mobility of the fingers, evaluated using the Total Active Motion (TAM) was 145° (75°-270°). The Kapandji score reached 8 for the thumb. Grip strength reached 21kg/F and pinch strength was 5kg/F; these values were 50% of those in the healthy hand. The induced-membrane technique is simple and can be used to treat traumatic bone loss in an emergency, thus avoiding amputation and limb shortening, while preserving limb function. It provides immediate stability and allows early mobilization.
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Affiliation(s)
- V Moris
- Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France.
| | - F Loisel
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
| | - D Cheval
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France
| | - L A See
- Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France.
| | - A Tchurukdichian
- Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France.
| | - I Pluvy
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
| | - F Gindraux
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France
| | - J Pauchot
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
| | - N Zwetyenga
- Service de chirurgie plastique et reconstructrice, 14, rue Paul-Gaffarel, 21079 Dijon, France.
| | - L Obert
- Service de chirurgie orthopédique, hôpital Jean-Minjoz, 3, boulevard Alexandre-Fleming, 25030 Besançon, France.
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Katz TL, Hunter-Smith DJ, Matthew Rozen W. Reverse second dorsal metacarpal artery vascularized bone flap for index distal bone loss: A case report. Microsurgery 2015; 36:250-3. [PMID: 26481898 DOI: 10.1002/micr.22519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 08/09/2015] [Accepted: 10/02/2015] [Indexed: 11/12/2022]
Abstract
Fingertip trauma with resultant bony loss is optimally reconstructed with an autologous bone substitute, offering a unique opportunity for use of a local vascularized bone graft. The second dorsal metacarpal artery is well-described for use in soft tissue and bony reconstruction, with recent cadaveric studies suggesting a reverse-flow second dorsal metacarpal artery bone flap could reach defects in the distal phalanx. The aim of the current report is to illustrate the use of this technique in reconstructing the distal digit in a traumatized index finger with bony loss of the middle third of the distal phalanx. A 49-year-old man presented with a traumatic circular saw injury to his left index finger, with the unique finding of distal phalanx bony loss to the middle third of this bone, with no associated disruption of palmar or dorsal structures. Reconstructive goals were solely that of bony reconstruction, with no soft tissue coverage required. A reverse SDMA vascularized bone flap was successfully used for reconstruction, with the vascularized bone flap mobilized on its reverse SDMA pedicle and pivoted at the level of the distal anastomoses between the palmar and dorsal metacarpal arteries. There was uncomplicated donor and recipient site closures, and good functional outcomes with the ability to retain full distal interphalangeal joint motion and force on distal pinch grip. This case shows that the reverse second dorsal metacarpal artery vascularized bone flap may be undertaken to reconstruct bony loss in the distal phalanx.
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Affiliation(s)
- Tanya L Katz
- Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Monash University, Frankston, Victoria, 3199, Australia.,Department of Surgery, Monash University, Monash Medical Centre, Clayton, Victoria, 3168, Australia
| | - David J Hunter-Smith
- Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Monash University, Frankston, Victoria, 3199, Australia.,Department of Surgery, Monash University, Monash Medical Centre, Clayton, Victoria, 3168, Australia
| | - Warren Matthew Rozen
- Plastic and Reconstructive Surgery Unit (Peninsula Clinical School), Peninsula Health, Monash University, Frankston, Victoria, 3199, Australia.,Department of Surgery, Monash University, Monash Medical Centre, Clayton, Victoria, 3168, Australia
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Soong M. Thumb proximal phalanx reconstruction with nonvascularized corticocancellous olecranon bone graft. Orthopedics 2015; 38:58-61. [PMID: 25611412 DOI: 10.3928/01477447-20150105-90] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 06/02/2014] [Indexed: 02/03/2023]
Abstract
Large segmental bone defects of the phalanges reportedly have been treated with free vascularized grafts from the hand, foot, or knee, or with nonvascularized grafts from the iliac crest. A nonvascularized structural corticocancellous graft from a local site would be advantageous. The olecranon has been used as a source of both cancellous and corticocancellous graft. The authors describe a unique case of the use of nonvascularized corticocancellous olecranon bone graft for structural purposes in a mutilating thumb injury. The patient injured the left thumb with a miter saw, resulting in a large degloving wound over a severely comminuted fracture of the proximal phalanx, with segmental bone loss between a base fragment and displaced condylar fragments. Provisional pin fixation was performed at the time of initial emergent irrigation and debridement, along with repairs of the extensor pollicis longus, radial digital nerve, and dorsal digital nerve. This was followed 3 weeks later by non-vascularized corticocancellous bone grafting from the olecranon to the proximal phalanx under regional anesthesia. The thumb was mobilized at 11 weeks, and solid union was radiographically confirmed at 6 months. The patient achieved moderate active range of motion and was able to return to work as a physical therapist. The elbow healed uneventfully and without pain or fracture at the donor site. This case shows that robust structural bone graft for the phalanges may be obtained from the nearby olecranon, under regional anesthesia, without microsurgery, and with potential advantages over the iliac crest.
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Sauvetage par membrane induite d’un pouce après transfert vascularisé d’hallux septique. ACTA ACUST UNITED AC 2012; 31:41-4. [DOI: 10.1016/j.main.2011.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 11/02/2011] [Accepted: 12/03/2011] [Indexed: 11/22/2022]
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del Piñal F, García-Bernal FJ, Thams C, Studer A, Regalado J. Informe sobre el trasplante de 250 dedos del pie a la mano consecutivos. Indicaciones, resultados, fracasos y nuevas aplicaciones. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2011.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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del Piñal F, García-Bernal FJ, Thams C, Studer A, Regalado J. Report on 250 consecutive toe to finger transplants. Indications, results, failures, and new applications. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/s1988-8856(11)70316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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22
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Masquelet AC, Obert L. [Induced membrane technique for bone defects in the hand and wrist]. ACTA ACUST UNITED AC 2010; 29 Suppl 1:S221-4. [PMID: 21084208 DOI: 10.1016/j.main.2010.10.007] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The induced membrane technique of bone reconstruction initially proposed for long bone defects can be extended to the hand and wrist defects. The two stages procedure is particularly useful in infected lesions or when the viability of the segment is not initially acquired. It avoids to have recurs to vascularised bone transfers which are not reliable in septic conditions and not easily performed in emergency. The induced membrane technique offers great capacities of bone reconstruction whatever the sizes of the defect.
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Affiliation(s)
- A C Masquelet
- Service de chirurgie orthopédique, traumatologique et réparatrice, hôpital Avicenne, 125 route de Stalingrad, Bobigny, France.
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23
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Malizos KN, Dailiana ZH, Innocenti M, Mathoulin CL, Mattar R, Sauerbier M. Vascularized bone grafts for upper limb reconstruction: defects at the distal radius, wrist, and hand. J Hand Surg Am 2010; 35:1710-8. [PMID: 20888511 DOI: 10.1016/j.jhsa.2010.08.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Accepted: 08/03/2010] [Indexed: 02/02/2023]
Abstract
Vascularized bone grafts have been successfully applied for the reconstruction of bone defects at the forearm, distal radius, carpus, and hand. Vascularized bone grafts are most commonly used in revision cases in which other approaches have failed. Vascularized bone grafts can be obtained from a variety of donor sites, including the fibula, the iliac crest, the distal radius (corticocancellous segments and vascularized periosteum), the metacarpals and metatarsals, and the medial femoral condyle (corticoperiosteal flaps). Their vascularity is preserved as either pedicled autografts or free flaps to carry the optimum biological potential to enhance union. The grafts can also be transferred as composite tissue flaps to reconstruct compound tissue defects. Selection of the most appropriate donor flap site is multifactorial. Considerations include size matching between donor and defect, the structural characteristics of the graft, the mechanical demands of the defect, proximity to the donor area, the need for an anastomosis, the duration of the procedure, and the donor site morbidity. This article focuses on defects of the distal radius, the wrist, and the hand.
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Affiliation(s)
- Konstantinos N Malizos
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessalia, Larissa, Greece.
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Flamans B, Pauchot J, Petite H, Blanchet N, Rochet S, Garbuio P, Tropet Y, Obert L. Pertes de substance osseuse à la main et au poignet traitées en urgence par technique de la membrane induite (technique de Masquelet). ACTA ACUST UNITED AC 2010; 29:307-14. [DOI: 10.1016/j.main.2010.06.008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 06/28/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
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Ozçelik IB, Kabakas F, Mersa B, Purisa H, Sezer I, Ertürer E. Treatment of nonunions of the distal phalanx with olecranon bone graft. J Hand Surg Eur Vol 2009; 34:638-42. [PMID: 19587077 DOI: 10.1177/1753193409104494] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Distal phalangeal fractures are the most common fractures of the hand but nonunions are unusual in the distal phalanx. Eleven patients were operated on for nonunions of the distal phalanx. The diagnosis of nonunion was made by the presence of the clinical (pain, deformity, instability) and radiological signs of nonunion more than 4 months after the initial injury. Three patients had developed infection and four of them had bone resorption after their initial treatments, which probably caused nonunion. Olecranon bone grafting combined with Kirschner wire fixation was done in all patients. The mean follow up was 7 months (range 5-18 months). There were no major complications at the donor or recipient sites. One patient had a haematoma formation at the donor site. There was complete radiological union of bone-grafted sites in all patients except one. There were no cases of pain, deformity, or instability after the treatment. The olecranon bone graft was found to be safe and easy to harvest. Its strong tubular structure replaced the distal phalanx successfully.
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Affiliation(s)
- I B Ozçelik
- IST-El Hand Surgery, Microsurgery, and Rehabilitation Group, TEM Hospital Hand Surgery Department - Gaziosmanpaşa Hospital Hand Surgery Department, Istanbul, Turkey
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del Piñal F, García-Bernal FJ, Studer A, Ayala H, Cagigal L, Regalado J. Super-thinned iliac flap for major defects on the elbow and wrist flexion creases. J Hand Surg Am 2008; 33:1899-904. [PMID: 19084199 DOI: 10.1016/j.jhsa.2008.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 08/22/2008] [Accepted: 09/20/2008] [Indexed: 02/02/2023]
Abstract
Four free iliac flaps were used to treat or prevent flexion contracture at the elbow or wrist flexion crease. Flap size ranged from 13 x 6 cm to 18 x 8 cm. Two flaps were used for primary coverage, and the other 2 flaps were used to treat established flexion contractures. All flaps survived without vascular complications. Full range of motion was obtained at the elbow and 40 degrees of active extension was obtained at the wrist. The flap has a very thin dermis with minimal panniculus that can be thinned as required, making it ideal to cover flexion creases. Despite the fact that anatomic variations are common in the inguinal region, the flap can be expeditiously and safely elevated. If needed, pedicle length can be up to 8 to 10 cm. The donor site is comparable with that of a full-thickness skin graft harvested from the groin. The donor artery, however, can be very small.
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27
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Kotwal PP, Nagaraj C, Gupta V. Vascularised joint transfer in the management of recurrent giant cell tumour of the second metacarpal. J Hand Surg Eur Vol 2008; 33:314-6. [PMID: 18562363 DOI: 10.1177/1753193408089048] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This paper presents the medium-term follow-up results (34 and 40 months, respectively) of two cases of recurrent giant cell tumour of the head of the second metacarpal, treated by marginal excision and reconstruction with a vascularised toe joint transfer. Both patients had painless, stable joints with excellent ranges of motion at the metacarpophalangeal joint of 80 degrees and 70 degrees , respectively, no degenerative changes and no recurrence of the tumours.
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Affiliation(s)
- P P Kotwal
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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del Piñal F, Innocenti M. Evolving concepts in the management of the bone gap in the upper limb. Long and small defects. J Plast Reconstr Aesthet Surg 2007; 60:776-92. [PMID: 17452133 DOI: 10.1016/j.bjps.2007.03.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Accepted: 03/07/2007] [Indexed: 11/18/2022]
Abstract
Vascularised bone graft is a well accepted technique when dealing with long defects. Its role in refractory nonunion, in small defects and in the growing patient is rarely discussed. In this paper the authors review the different alternatives to deal with bone defects in the upper extremity. The indications of vascularised corticoperiosteal graft for solving small defects harbouring refractory nonunion, and the use of vascularised bone phalanx and metatarsal for complex - but small - defects in the fingers is presented. The ability of the bone to grow and remodel when a living epiphysis is included, and to maintain the cartilage viability when a composite osteochondral graft is transferred are also discussed.
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Affiliation(s)
- Francisco del Piñal
- Unit of Hand-Wrist and Plastic Surgery, Hospital Mutua Montañesa, Instituto de Cirugía Plástica y de la Mano, Santander, Spain.
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Del Piñal F, García-Bernal FJ, Regalado J, Ayala H, Cagigal L, Studer A. Vascularised corticoperiosteal grafts from the medial femoral condyle for difficult non-unions of the upper limb. J Hand Surg Eur Vol 2007; 32:135-42. [PMID: 17240497 DOI: 10.1016/j.jhsb.2006.10.015] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Revised: 10/07/2006] [Accepted: 10/18/2006] [Indexed: 02/03/2023]
Abstract
The vascularised corticoperiosteal graft was introduced by Sakai and Doi, in 1991, as a means to achieve bony union under unfavourable conditions. We present our experience with this vascularised graft, taken from the femoral condyle, in six patients with difficult non-unions (5) or other bony problems (1) in the upper limb. In five cases, a long bone defect--two humeral, two ulnar and one radial--was involved. All had had between three and seven previous operations. Two of the non-unions were secondary to infection. The others had had conventional grafting on two or three previous occasions each. In the sixth case, a corticoperiosteal graft was used to promote healing in a combined carpometacarpal and intercarpal dislocation with a very poor bed. All of the grafts survived without complications and all of the bones healed radiologically in less than three months. Three patients achieved a normal range of motion and two obtained a functional range of motion with only slight limitations. The carpometacarpal arthrodesis was healed soundly at five weeks.
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Affiliation(s)
- F Del Piñal
- From the Instituto de Cirugía Plástica y de la Mano, Private Practice and Hospital Mutua Montañesa Santander, Spain.
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del Piñal F, García-Bernal FJ, Regalado J, Studer A, Cagigal L, Ayala H. The tibial second toe vascularized neurocutaneous free flap for major digital nerve defects. J Hand Surg Am 2007; 32:209-17. [PMID: 17275596 DOI: 10.1016/j.jhsa.2006.11.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Revised: 11/14/2006] [Accepted: 11/14/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE Most digital nerve defects can be reconstructed by means of nonvascularized nerve grafts or artificial tubes, for example. When the bed is poor, the defect is long, or there is a concomitant soft-tissue loss; however, a vascularized nerve graft may be a better option. Our purpose is to introduce a method of 1-stage reconstruction of complex neurocutaneous defects in the fingers and to report the results and clinical effectiveness at a minimum 1-year follow-up period. METHODS From 1997 to 2005 there were 6 consecutive patients who had a combined soft-tissue and digital nerve defect reconstructed by a vascularized neurocutaneous flap from the tibial (medial) side of the second toe. Three were acute and 3 were chronic cases. One flap was used for the ulnar side of the thumb, 2 for the radial aspect of the index finger, 1 for the radial of the small finger, and 2 for the ulnar side of the small finger. The nerve gap averaged 4.2 cm, and the flap size averaged 3.2 x 2.1 cm. The flaps were revascularized with standard microsurgical techniques to local vessels in the fingers. The nerves were sutured with epineural stitches. A split-thickness skin graft was used to close the donor site of the toe. RESULTS All flaps survived without complications. At the latest follow-up evaluation static two-point discrimination (s2PD) averaged 8 mm on the pulp. Three patients had normal sensation when tested with Semmes-Weinstein filaments. Subjective feeling was 78% of that of the normal side. Five patients rated their feeling as excellent on a subjective scale. The Disabilities of the Arm, Shoulder, and Hand questionnaire score averaged 5. CONCLUSIONS The tibial neurocutaneous second toe free flap is suitable for reconstructing a missing nerve and soft-tissue defect in the finger. We found good functional recovery and high satisfaction in this group of patients. The donor site morbidity has been minimal, although delayed healing is common. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Francisco del Piñal
- Instituto de Cirugía Plástica y de la Mano, Hospital Mutua Montañesa, Santander, Spain.
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del Piñal F, García-Bernal FJ, Pisani D, Regalado J, Ayala H, Studer A. Dry arthroscopy of the wrist: surgical technique. J Hand Surg Am 2007; 32:119-23. [PMID: 17218184 DOI: 10.1016/j.jhsa.2006.10.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Accepted: 10/23/2006] [Indexed: 02/02/2023]
Abstract
PURPOSE To present a method to perform arthroscopic exploration and instrumentation without infusing any fluid. METHODS The hand is suspended from a bow, with traction on all fingers. Portals are developed as in the classic (wet) wrist arthroscopic procedure except that no water is infused to distend the joint and create the optic cavity. For this procedure the joint must be dried; we use suction through the synoviotomes and neurosurgical patties to accomplish this. RESULTS We have performed more than 100 wrist arthroscopies using the dry technique without any undue difficulty. CONCLUSIONS The dry technique is as effective as the classic procedure, without the cumbersome leakage of water or the risk of compartment syndrome. It allows some sophisticated arthroscopic procedures to be performed that would be impracticable with water. In addition from these benefits, if open surgery is performed after the arthroscopic exploration then the tissue planes are dry, making surgery much easier. The technique is believed to be inappropriate if thermal probes are used. A learning curve exists.
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Affiliation(s)
- Francisco del Piñal
- Instituto de Cirugía Plástica y de la Mano, Hospital Mutua Montañesa, Santander, Spain.
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