Reconstruction of Fingers Using Skin-Bone Grafts with Microvascular Anastomoses

Abstract

The aim of the study was to present a clinical and anatomical rationale for transplantation of skin-bone grafts with microvascular anastomoses for treating terminal and segmental defects of the hand and fingers. Materials and Methods. Finger and metacarpal bones were reconstructed in 25 hands of 25 patients by transplanting skin-bone tubular fragments with microvascular anastomoses. Transplants from the second metatarsal bone (n=22) and fibula (n=3) were used. Clinical, radiological, morphological, biomechanical, biophysical, and statistical research methods were used. The developed technology is adjustable to individual vascular anatomy of the foot. The proposed use of non-free skin-fat flaps and skin-bone fragments with microvascular anastomoses has been implemented for reconstructing lost segments. Results. The engraftment of skin-bone fragments was observed in 25 cases. In two cases, partial necrosis of the transplants was detected. Sufficient resistance of the transplanted bone graft to resorption was noted. According to the X-ray evidence, the length of the finger with the metacarpal bone after surgery was 8.44±0.32 cm, in the short term after surgery-8.10±0.36 cm, and in the long term-7.87±0.45 cm, indicating mild resorption. We used an individual approach to the transplant selection, which made it possible to obtain generally good long-term results in 3 patients, and satisfactory results-in 22 patients. Conclusion. The study showed the feasibility of transplanting skin-bone fragments with microvascular anastomoses for replacing various anatomical defects of the hand and fingers. The proposed modification takes into account the variability of vascular anatomy of the donor region.