Archives of Orthopaedic and Trauma Surgery

, Volume 137, Issue 5, pp 719–723 | Cite as

Finger reconstruction using induced membrane technique and ulnar pedicled forearm flap: a case report

  • Olivier Herisson
  • Alain-Charles Masquelet
  • Levon Doursounian
  • Alain Sautet
  • Adeline Cambon-Binder
Handsurgery
First Online:
Received:
  • 254 Downloads

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.

Keywords

Rollover hand Masquelet technique Induced membrane technique Ulnar artery forearm flap Bone reconstruction 
This is a preview of subscription content, log in to check access.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Funding

There is no funding source.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from the participant included in the study.

References

  1. 1.
    Charters AC, Davis JW (1978) The roll-bar hand. J Trauma 18(8):601–604CrossRefPubMedGoogle Scholar
  2. 2.
    Harris CN, Wood VE (1978) Rollover injuries of the upper extremity. J Trauma 18(8):605–607CrossRefPubMedGoogle Scholar
  3. 3.
    Masquelet AC, Fitoussi F, Begue T, Muller GP (2000) Reconstruction des os longs par membrane induite et autogreffe spongieuse. Ann Chir Plast Esthet 45(3):346–353PubMedGoogle Scholar
  4. 4.
    Hudak PL, Amadio PC, Bombardier C (1996) Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity Collaborative Group (UECG). Am J Ind Med 29(6):602–608CrossRefPubMedGoogle Scholar
  5. 5.
    Godina M (1986) Early microsurgical reconstruction of complex trauma of the extremities. Plast Reconstr Surg 78(3):285–292CrossRefPubMedGoogle Scholar
  6. 6.
    Reid DAC (1974) Hand injuries requiring skin replacement and restoration of tendon function. Br J Plast Surg 27(1):5–18CrossRefPubMedGoogle Scholar
  7. 7.
    Scheker LR, Langley SJ, Martin DL, Julliard KN (1993) Primary extensor tendon reconstruction in dorsal hand defects requiring free flaps. J Hand Surg Edinb Scotl 18(5):568–575CrossRefGoogle Scholar
  8. 8.
    Lister G, Scheker L (1988) Emergency free flaps to the upper extremity. J Hand Surg 13(1):22–28CrossRefGoogle Scholar
  9. 9.
    Bieber EJ, Wood MB (1986) Bone reconstruction. Clin Plast Surg 13(4):645–655PubMedGoogle Scholar
  10. 10.
    Yajima H, Tamai S, Ono H, Kizaki K (1998) Vascularized bone grafts to the upper extremities. Plast Reconstr Surg 101(3):727–735CrossRefPubMedGoogle Scholar
  11. 11.
    Roux JL (2003) Transferts osseux vascularisés au poignet et à la main. Chir Main 22(4):173–185CrossRefPubMedGoogle Scholar
  12. 12.
    Del Piñal F, García-Bernal FJ, Delgado J, Sanmartín M, Regalado J, Cagigal L (2006) Vascularized bone blocks from the toe phalanx to solve complex intercalated defects in the fingers. J Hand Surg 31(7):1075–1082CrossRefGoogle Scholar
  13. 13.
    Pelissier P, Masquelet AC, Bareille R, Pelissier SM, Amedee J (2004) Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res Off Publ Orthop Res Soc 22(1):73–79CrossRefGoogle Scholar
  14. 14.
    Pelissier P, Martin D, Baudet J, Lepreux S, Masquelet A-C (2002) Behaviour of cancellous bone graft placed in induced membranes. Br J Plast Surg 55(7):596–598CrossRefPubMedGoogle Scholar
  15. 15.
    Flamans B, Pauchot J, Petite H, Blanchet N, Rochet S, Garbuio P, Tropet Y, Obert L (2010) La technique de la membrane induite pour les pertes de substance osseuse de la main et du poignet. Chir Main 29(5):307–314CrossRefPubMedGoogle Scholar
  16. 16.
    Zappaterra T, Ghislandi X, Adam A, Huard S, Gindraux F, Gallinet D, Lepage D, Garbuio P, Tropet Y, Obert L (2011) Reconstruction des pertes de substance osseuse du membre supérieur par la technique de la membrane induite, étude prospective à propos de neuf cas. Chir Main 30(4):255–263CrossRefPubMedGoogle Scholar
  17. 17.
    Masquelet AC, Obert L (2010) La technique de la membrane induite pour les pertes de substance osseuse de la main et du poignet. Chir Main 29:S221–S224CrossRefPubMedGoogle Scholar
  18. 18.
    Moris V, Guillier D, Rizzi P, De Taddeo A, Henault B, Tchurukdichian A, Zwetyenga N (2015) Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: a case report. JPRAS Open 6:31–39CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Glasson DW, Lovie MJ (1988) The ulnar island flap in hand and forearm reconstruction. Br J Plast Surg 41(4):349–353CrossRefPubMedGoogle Scholar
  20. 20.
    Grobbelaar AO, Harrison DH (1997) The distally based ulnar artery island flap in hand reconstruction. J Hand Surg Edinb Scotl 22(2):204–211CrossRefGoogle Scholar
  21. 21.
    Guimberteau JC, Goin JL, Panconi B, Schuhmacher B (1988) The reverse ulnar artery forearm island flap in hand surgery: 54 cases. Plast Reconstr Surg 81(6):925–932CrossRefPubMedGoogle Scholar
  22. 22.
    Hentz VR, Pearl RM (1987) Hand reconstruction following avulsion of all dorsal soft tissues. A cutaneo-tendinous free tissue transfer. Ann Chir Main 6(1):31–37CrossRefPubMedGoogle Scholar
  23. 23.
    Ulrich D, Fuchs P, Bozkurt A, Pallua N (2010) Free serratus anterior fascia flap for reconstruction of hand and finger defects. Arch Orthop Trauma Surg 130(2):217–222CrossRefPubMedGoogle Scholar
  24. 24.
    Quaba AA, Elliot D, Sommerlad BC (1988) Long term hand function without long finger extensors: a clinical study. J Hand Surg Edinb Scotl 13(1):66–71CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Orthopaedic, Trauma, and Hand SurgerySaint Antoine HospitalParisFrance
  2. 2.Université Pierre et Marie Curie Paris 6ParisFrance

Personalised recommendations