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Case Reports
. 2017 Aug;96(31):e7364.
doi: 10.1097/MD.0000000000007364.

Three-dimensional virtual planning in precise chimeric fibula free flap for metacarpal defects: A case report

Hui Shen  1 , Xiang-Qian Shen, Ying Lv, Hui Lu, Jing-Hong Xu, Shou-Cheng Wu
Affiliations
Case Reports

Three-dimensional virtual planning in precise chimeric fibula free flap for metacarpal defects: A case report

Hui Shen et al. Medicine (Baltimore). 2017 Aug.

Abstract

Rationale: Metacarpal and phalanx defects with soft tissue loss were suggested to be reconstructed by vascularized bone flap. The fibular osteocutaneous flap is a preferred method. Three-dimensional virtual planning has successfully applied in mandibular reconstruction with fibular free flap. We applied three-dimensional virtual planning in precise fibula flap harvest to maintain the continuity of the fibula and to achieve accurate metacarpal and phalanx reconstruction.

Patient concerns: A 35-year-old male presented with extensive soft tissue defects and first metacarpal defect involving the first metacarpophalangeal joint.

Diagnoses: There were 4 cm of first metacarpal defect involving the first metacarpophalangeal joint and soft tissue defects of 5cm × 3cm + 3cm × 2cm.

Interventions: By combining three-dimensional virtual planning, we harvested a chimeric fibular flap. The precise fibula partial osteotomies were performed with cutting guides designed in virtual planning.

Outcomes: All the chimeric flaps survived and no significant donor-site morbidity was noted. Michigan Hand Outcome Questionnaire scores indicated acceptable functional results.

Lessons: Our preliminary experience with the approach of three-dimensional virtual planning in precise chimeric fibula free flap is practical and efficient. Although more cases and follow-up are needed to evaluate it, this approach is expected to benefit patients.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
(A) A 35-year-old male patient sustained a right-hand crush injury. (B) There were more than 4 cm defect of the first metacarpal, involving the 1st metacarpophalangeal joint.
Figure 2
Figure 2
(A) The fibular chimeric flap was designed (A1 and A2, skin paddles for soft tissue defects; P1 and P2, perforators for skin paddle A1 and A2; and B, bone flap). (B, C) The chimeric fibular osteocutaneous flap is carefully harvested and positioned.
Figure 3
Figure 3
(A, B) According to the virtual planning, the fibula bone segment was designed on the posterior margin of fibula.
Figure 4
Figure 4
(A) Fibula partial osteotomy cutting guide is designed in 2 parts (part A and B). (B) The cutting guide is locked to the anterior and posterior margin of fibula. Precise osteotomies are performed through groove a and b with a reciprocating saw. Then part B is removed and osteotomy of groove c is performed. The 1st layer of cortex is sawn with a reciprocating saw. The 2nd layer of cortex was carefully sawn with a sagittal saw to avoid injury to the peroneal artery.
Figure 5
Figure 5
(A, B) The thumb tactile sensation and function were found satisfactory in the 3 months follow-up.
See this image and copyright information in PMC

References

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