Vascularized iliac osteocutaneous flap for management of mutilated hand

Abstract

Objective To investigate the treatment effect of one stage reconstruction of mutilated hand with multiple metacarpal composite tissue defect using vascularized iliac osteocutaneous flap, palm tissue defect accompanied with multiple metacarpal bones defect by iliac flap through anastomosing deep iliac circumflex artery. Methods Since 1996, 8 patients with serious mutilating injury of the palm that resulted in multiple metacarpal bone and soft tissue defect underwent transfer of iliac osteocutaneous flap through anastomosing the deep iliac circumflex artery. Tendons and nerves were also repaired in the same stage. In 3 cases 2 metacarpal bones were missing, 3 cases had 3 metacarpal bones gone, while the other 2 cases with 4 metacarpal bone defect. The tendon and nerve defect in 6 cases were shorter than 2-3 cm and direct repair was achieved by shortening the bone graft. One stage Y osteotomy was done in 1 case of 2-5 metacarpal bone defect to increase bony contact surface and decrease the size of harvested iliac bone graft. One case underwent conventional lilac bone graft to the first metacarpal to restore independent thumb movement. Arthreplasty of the metacarpophalangeal joint was done in 2 cases with metacarpal head defect. Results All osteocutancous flaps survived. Wound healed in one-stage in 7 cases, and healed in second stage in 1 case because of swelling. During 1-3 years follow-up post-operatively, the clinical bony union lime was 3 to 5 weeks. There was no complication of the donor site. Hand function was graded excellent in 1 case, good in 5 cases, fair in 1 case, and bad in 1 case one year post-operatively. Conclusion Reconstruction of mutilated palm by transfer iliac osteccutaneous flap through anastomosing deep iliac circumflex artery and repairing tendons and nerves in one-stage can restore acceptable hand appearance and function. It is an effective treatment for mutilating hand injuries. Key words: Tissue transplantation; Hand injuries; Microsurgery; Iliac flaps; Reconstruction