Necrosis of the First Metacarpal Bone in a Case of Acute Lymphatic Leukemia in Childhood

Abstract

A 4-year-old girl suffering from acute lymphatic leukemia (ALL) was treated with cortisone and chemotherapy. During treatment a blister developed on the dorsum of her right hand, followed by a subsequent necrosis of the underlying tissue and of the first metacarpal bone. Recurrent suppression of bone marrow prevented an immediate single step reconstruction with a microvascular metatarsal bone transfer. Instead, the soft tissue defect was first covered with a pedicled groin flap and the skeleton of the thumb was supported with an external fixator. Then, a free fibular bone graft was transferred. During a complete remission of ALL, a microvascular transfer of the metatarsal bone and joint was finally performed. Two years after reconstruction the right hand is still the dominant one and both thumbs grow proportionately.