Traumatic composite metacarpal injuries result in abolition of the hand's structural and functional integrity. A one-stage procedure that combines composite free tissue transfer with tendon reconstruction is an ideal management since it affords simultaneous restoration of functional and structural integrity.
Seven free fibular osteoseptocutaneous flaps were used to reconstruct post-traumatic composite metacarpal defects between 1997 and 2003. Osteotomy of the vascularized fibula bone into 1 to 3 segmental struts were performed to restore single, neighboring, or alternative metacarpal bone defects, and a skin paddle used to resurface the dorsum of the hand. In addition, patients underwent simultaneous extrinsic extensor repairs, metacarpophalangeal joint fusions, and intrinsic extensor reconstructions. Six patients achieved primary wound healing and an expected functional recovery. One fibular flap failed despite re-exploration.
The fibular flap provides an ideal replacement of bone and skin for traumatic composite metacarpal defects. The diameter and quality of the fibular bone appropriately restores the metacarpal bones, and a thin skin paddle resurfaces the dorsal hand. Furthermore, fibular struts may be placed in a contiguous or alternating parallel arrangement, providing sufficient room to allow intrinsic and extrinsic tendon reconstruction.
