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

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 tissu...

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Main Authors: Vivien Moris, David Guillier, Philippe Rizzi, Alice De Taddeo, Benoit Henault, Alain Tchurukdichian, Narcisse Zwetyenga
Format: Article
Language:English
Published: Elsevier 2015-12-01
Series:JPRAS Open
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S2352587815000431
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spelling doaj-e1a9c79c25dc4c6a92581a36cc127a7f2020-11-25T01:57:11ZengElsevierJPRAS Open2352-58782015-12-016C313910.1016/j.jpra.2015.08.001Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case reportVivien MorisDavid GuillierPhilippe RizziAlice De TaddeoBenoit HenaultAlain TchurukdichianNarcisse ZwetyengaIntroduction: 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.http://www.sciencedirect.com/science/article/pii/S2352587815000431Bone defectInduced membraneBone substitutesHand trauma
collection DOAJ
language English
format Article
sources DOAJ
author Vivien Moris
David Guillier
Philippe Rizzi
Alice De Taddeo
Benoit Henault
Alain Tchurukdichian
Narcisse Zwetyenga
spellingShingle Vivien Moris
David Guillier
Philippe Rizzi
Alice De Taddeo
Benoit Henault
Alain Tchurukdichian
Narcisse Zwetyenga
Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report
JPRAS Open
Bone defect
Induced membrane
Bone substitutes
Hand trauma
author_facet Vivien Moris
David Guillier
Philippe Rizzi
Alice De Taddeo
Benoit Henault
Alain Tchurukdichian
Narcisse Zwetyenga
author_sort Vivien Moris
title Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report
title_short Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report
title_full Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report
title_fullStr Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report
title_full_unstemmed Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report
title_sort complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: a case report
publisher Elsevier
series JPRAS Open
issn 2352-5878
publishDate 2015-12-01
description 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.
topic Bone defect
Induced membrane
Bone substitutes
Hand trauma
url http://www.sciencedirect.com/science/article/pii/S2352587815000431
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