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Filling of Tissue Defects in the Hand With A Pediculed Osteocutaneous Groin Flap

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Jabłecki J., Kaczmarzyk L., Domanasiewicz A., Paruzel M.

Polish Journal of Surgery

2009

vol. 81

issue 5

230-235

The aim of the study was to evaluate the efficacy of pedicled osteocutaneous groin flaps in treatment of tissue defects of the hand.Material and methods. Twelve pedicled osteocutaneous groin flaps were used to fill bone defects of the hand in the same amount of patients (10 males and 2 females) aged 20-53 years (mean 33.4 years, SD 12 years). The defects affected metacarpal bones and wrist in 2 cases, metacarpus alone in 3 cases, fingers - in 4 (total amputations of 3 or 4 fingers), and thumb in 3 (total amputations). The osseous fragment measured from 6-18 ccm (mean 12.4 ccm). The osteosynthesis was performed using K-wires (10 patients) or AO headless cortical screw (2 patients). The flaps were detached gradually starting from postoperative day 18 with the final detachment performed on p.o. day 24-33 (mean 27.2 days, SD 6 days). Once after flap detachment the patients maintained the limb immobilized in a plaster cast for 5 weeks.Beside local abscess which was successfully treated with compresses, healing of the surgical site was uncomplicated. The bony union was assessed radiological and occurred after 9-13 weeks (mean 11.1 weeks, SD 5 weeks). Due to delayed bone union, one patient required bone slivers grafting which finally lead to unification. All the patients needed secondary plastic surgery of subcutaneous tissue of the flap; however, only 9 of them consented to it. In three patients we substituted the sensibility with a nerve graft according to Holevich.Results. The described operation did not improve function in patients with wrist-level and metacarpal osseous defects but improved its esthetical aspect; in the other patients the hand function was significantly restored.Conclusions. In patients disqualified for other methods of reconstructions of the thumb, fingers and bone defects of the hand a satisfactory result may be achieved by using pedicled osteocutaneous flaps from the iliac crest. This method proved to be highly effective.

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1 Polish Journal of Surgery

1 2009

1 Domanasiewicz A.

1 Jabłecki J.

1 Kaczmarzyk L.

1 Paruzel M.

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Filling of Tissue Defects in the Hand With A Pediculed Osteocutaneous Groin Flap