Application of Ilizarov technique in functional reconstruction of thumb degloving injury after amputation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 WANG Bin ¹ , WANG Hui ¹ , MENG Zhao ² , LIU Wei ¹ , HAO Ruizheng ¹ , ZHANG Jian ¹ , HUO Yongxin ¹ , CHEN Chao ¹ , JIA Song ¹

1. Department of Hand Surgery, Repair and Reconstruction Surgery, the Second Hospital of Tangshan (the Affiliated Hospital of North China Polytechnic University), Tangshan Hebei, 063000, P.R.China;
2. Department of Orthopedics, Hebei Children’s Hospital, Shijiazhuang Hebei, 050000, P.R.China;

Corresponding author：

WANG Bin, Email: wbladyp3@163.com

Keywords：

Thumb reconstruction; metacarpal lengthening; Ilizarov technology; degloving injury

DOI：

10.7507/1002-1892.201803047

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ObjectiveTo investigate the effectiveness of Ilizarov technique in reconstruction of thumb function in patients with thumb degloving injury after amputation.MethodsBetween June 2011 and September 2016, 9 cases of thumb degloving injury were treated with amputation and Ilizarov technology. There were 8 males and 1 female with an age of 18-52 years (mean, 34.7 years). The amputation plane was the level of the metacarpophalangeal joint in 5 cases, the level of the proximal metacarpophalangeal joint in 2 cases, and the level of the base of the proximal phalanx in 2 cases (the length of proximal phalanx was less than 1 cm). After amputation, the affected finger was shorter than the healthy finger by 4.0-7.5 cm, with an average of 5.7 cm. On the fifth day after operation, the semi-loop external fixation extender was applied for extension, which was extended by 0.5 mm per day, and was extended once every 6 hours.ResultsAfter bone lengthening surgery, the first web space elevation and contracture occurred in 8 cases. Six of them were treated with the amputation of the inner muscle of the thumb and the "Z" forming technique, postoperative thumb function recovered well; the remaining 2 cases rejected plasty. All 9 patients were followed up 14-47 months, with an average of 33 months. Bone lengthening time was 64-122 days, with an average of 86 days. The lengthening length of bone was 3.0-5.9 cm, with an average of 4.1 cm, and the average lengthening length was 71.9% of the average shortened length. The fixation time of external fixator was 169-342 days, with an average of 231 days. The healing index was 43.2-59.1 days/cm, with an average of 53.4 days/cm. One case showed prolonged mineralization delay and recovered after "accordion" treatment. Bone healing was finally achieved in all patients, with the healing time ranging from 169 to 342 days, with an average of 231 days. No replantation internal fixation and flexion contracture occurred. The two-point discrimination of extended fingertip was similar to that of normal fingertip. The grip strength reached 53%-89% of the healthy side; the kneading force reached 59%-91% of the healthy side.ConclusionThe application of Ilizarov technology to extend the thumb metacarpal lengthening is a good method to reconstruction the thumb function after degloving injury.

Citation： WANG Bin, WANG Hui, MENG Zhao, LIU Wei, HAO Ruizheng, ZHANG Jian, HUO Yongxin, CHEN Chao, JIA Song. Application of Ilizarov technique in functional reconstruction of thumb degloving injury after amputation. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(12): 1545-1548. doi: 10.7507/1002-1892.201803047 Copy

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10.	Bozan ME, Altinel L, Kuru I, et al. Factors that affect the healing index of metacarpal lengthening. J Orthop Surg, 2006, 14(2): 167-171.
11.	Hosny GA, Kandel WA. Distraction lengthening by callotasis of traumatically shortened bones of the hand. J Trauma Acute Care Surg, 2012, 72(6): 1676-1680.
12.	Matev IB. Thumb reconstruction through metacarpal bone lengthening. J Hand Surg (Am), 1980, 5(5): 482-487.
13.	Arslan H. Metacarpal lengthening by distraction osteogenesis in childhood brachydactyly. Acta Orthop Belg, 2001, 67(3): 242-247.
14.	Matev IB. Thumb metacarpal lengthening. Tech Hand Up Extrem Surg, 2003, 7(4): 157-163.
15.	Vekris M, Lykissas M, Pakos E, et al. Digital ray reconstruction through distraction osteogenesis: a retrospective study of 82 rays with long-term follow-up. Injury, 2015, 46(7): 1354-1358.
16.	Parmaksizoğlu F, Beyzadeoglu T. Lengthening of the phalanges by callus distraction in traumatic amputations of the fingers. Acta Orthop Traumatol Turc, 2004, 38(1): 60-66.
17.	Salom M, Aroca JE, Chover V, et al. Distraction lengthening of digital rays using a small exernal fixator. J Hand Surg (Br), 1998, 23(6): 781-784.

1. 王澍寰. 手外科学. 3 版. 北京: 人民卫生出版社, 2011: 486-487.
2. Wei FC, Henry SL. Toe-to-hand transplantation//Scott WW, ed. Green’s Operative Hand Surgery. 6th eds. Philadelphia: Elsevier, 2011: 1087-1815.
3. 王斌, 贾松, 卢爱东, 等. 第二趾背甲皮瓣联合中环指岛状皮瓣修复拇指脱套伤的临床研究. 中国修复重建外科杂志, 2016, 30(11): 1383-1386.
4. Ünal MB, Cansü E, Parmaksizoğlu F. Lengthening of a thumb fistal phalanx replanted to its metacarpus because of loss of the proximal phalanx: case report. J Hand Surg (Am), 2011, 36(4): 661-664.
5. Matev IB. Thumb reconstruction after amputation at the metacarpo-phalangeal joint by bone-lengthening: a preliminary report of three cases. J Bone Joint Surg (Am), 1970, 52(4): 957-965.
6. Manktelow RT, Wainwright DJ. A technique of distraction osteosynthesis in the hand. J Hand Surg (Am), 1984, 9(6): 858-862.
7. Heitmann C, Levin LS. Distraction lengthening of thumb metacarpal. J Hand Surg (Br), 2004, 29(1): 71-75.
8. Erdem M, Sen C, Eralp L, et al. Lengthening of short bones by distraction osteogenesis—results and complications. Int Orthop, 2009, 33(3): 807-813.
9. Finsen V, Russwurm H. Metacarpal lengthening after traumatic amputation of the thumb. J Bone Joint Surg (Br), 1996, 78(1): 133-136.
10. Bozan ME, Altinel L, Kuru I, et al. Factors that affect the healing index of metacarpal lengthening. J Orthop Surg, 2006, 14(2): 167-171.
11. Hosny GA, Kandel WA. Distraction lengthening by callotasis of traumatically shortened bones of the hand. J Trauma Acute Care Surg, 2012, 72(6): 1676-1680.
12. Matev IB. Thumb reconstruction through metacarpal bone lengthening. J Hand Surg (Am), 1980, 5(5): 482-487.
13. Arslan H. Metacarpal lengthening by distraction osteogenesis in childhood brachydactyly. Acta Orthop Belg, 2001, 67(3): 242-247.
14. Matev IB. Thumb metacarpal lengthening. Tech Hand Up Extrem Surg, 2003, 7(4): 157-163.
15. Vekris M, Lykissas M, Pakos E, et al. Digital ray reconstruction through distraction osteogenesis: a retrospective study of 82 rays with long-term follow-up. Injury, 2015, 46(7): 1354-1358.
16. Parmaksizoğlu F, Beyzadeoglu T. Lengthening of the phalanges by callus distraction in traumatic amputations of the fingers. Acta Orthop Traumatol Turc, 2004, 38(1): 60-66.
17. Salom M, Aroca JE, Chover V, et al. Distraction lengthening of digital rays using a small exernal fixator. J Hand Surg (Br), 1998, 23(6): 781-784.

Chinese Journal of Reparative and Reconstructive Surgery

Application of Ilizarov technique in functional reconstruction of thumb degloving injury after amputation

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