Masquelet technique with transfer of free iliac inguinal flap in reconstruction of infectious bone and soft tissue defect after metacarpal fracture surgery: a report of 16 cases / 中华显微外科杂志

ABSTRACT

Objective:To investigate the clinical effects of Masquelet technique with the transfer of free iliac inguinal flap in reconstruction of infectious bone and soft tissue defect after metacarpal fracture surgery.Methods:From January 2014 to January 2020, 16 patients suffered from infectious bone and soft tissue defect after surgery of metacarpal fracture were treated in Department of Hand Surgery, Institute for Hygiene of Ordnance Industry (Weapon Industry 521 Hospital). Debridement and vacuume sealing drainage (VSD) coverage of wound were carried out in emergency surgery, and Masquelet technique combined with free iliac inguinal flap for reconstruction of infected metacarpal bone defect were performed in sub-emergency surgery. The patients were 14 males and 2 females with an average age of 38 (20-50) years old. Plates were removed in 10 patients and retained in 6 patients. Defects of metacarpal bone ranged from 0.8 cm×0.8 cm×2.0 cm to 1.5 cm×2.0 cm× 5.1 cm in size. Soft tissue defects ranged from 3.6 cm×6.8 cm to 7.8 cm×11.6 cm. Tendon defects were found in all 16 patients. After the primary procedure of Masquelet technique combined with free iliac inguinal flap, routine anti-infection, anticoagulant, antispasmodic and other treatments were offered to all patients. Then all patients were observed by fortnightly reviews. After infection was cleared, the second phase of Masquelet treatment began. The defects of metacarpal bone were reconstructed with autologous cancellous bone grafts, and measures to prevent from infection together with other therapies were offered after the surgery. Follow-up of the second phase surgery was carried out once per 1-2 weeks and then per 2-4 months after bone union. The follow-up review items included: wound infection and necrosis, appearance, shape, texture and sensory recovery of flap. Bone union of infectious metacarpal defect was evaluated, recurrence of infection was closely observed as well as the resorption or nonunion of bone by X-rays. Hand function was assessed according to the Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association. Donor sites healing and functional recovery were also included in the postoperative observation.Results:The follow-up time ranged from 1.5-3.0 (average 2.4) years. There was no necrosis of iliac inguinal flap, no recurrence of infection, and the flaps all healed well. The appearance, shape and texture of flaps were found close to the adjacent skin in all patients. Two-point discriminations (TPD) of the transferred iliac inguinal flaps were at 8-10 mm. X-ray reviews showed that bone union achieved in all patients. The time of bone union were 2.1-3.4 months (2.9 months in average) after bone grafting. There was no bone resorption, infection or nonunion. According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 13 patients were excellent and 3 patients were good. All donor sites had primary healing with the motion of donor hips unaffected.Conclusion:Masquelet technique combined with free iliac inguinal flap is an effective, safe and feasible surgical procedure in reconstruction of infectious bone and soft tissue defect after metacarpal fracture surgery. It offers a satisfactory outcome with relatively less damage to the donor site.