Complex Syndactyly in the hand it is a challenge for surgical corrections. A critical point to assess is the reconstruction of the web space, while scarcity of skin it is often present. The web space should be always planned and designed to bring some function and covering of the deformities. The first web space has an importance to give function on grasping and pinch. In this report, we present a case of a complex syndactyly with a narrow first web space that was reconstructed by the second dorsal metacarpal artery flap. Despite of a critical malformation in the hand, the patient improved his pinch function and showed a good aesthetic outcome. We believe that this flap could be considered an alternative in dealing with this kind of condition and bring a satisfactory solution for web space reconstruction.
ResumoA tecnologia de impressão tridimensional (3D) é uma realidade no âmbito da medicina. Na Ortopedia e Traumatologia, a impressão 3D direciona um tratamento cirúrgico preciso e individualizado. Compreender e difundir suas aplicações, utilidades e resultados pode fomentar o academicismo e melhorar o cuidado ao paciente. Trata-se de relato de um caso raro de uma paciente adulta jovem com osteonecrose da cabeça umeral por necrose avascular desenvolvida na primeira infância. O tratamento foi individualizado e otimizado com a impressão 3D, que ajudou a determinar os passos para o procedimento de artroplastia parcial de úmero.
Background Bone grafts are widely used in orthopedic surgeries. Although the conventional iliac crest graft is still the largest source of cancellous and cortical-cancellous bone grafts, it may require a new surgical field and additional anesthesia. In contrast, the use of the distal radius graft allows removal in the same field; however, it is often the recipient site; thus, only a limited amount is usually available. In the upper limb, one of the possibilities is the use of the cancellous and/or cortical-cancellous graft from the olecranon. This was a primary and experimental study that aimed to analyze the versatility of using olecranon bone grafts through anatomical assessment of cadavers. Methods Eight upper limbs were dissected from four fresh, unclaimed, young cadavers, with no history of the previous pathology at the removal site to demonstrate the method of graft removal and to measure the quantity obtained in two situations, namely, removal of the cancellous graft and removal of the cortical-cancellous grafts. Results The average volume of the cancellous bone graft from the olecranon was 3.9 cm 3 (3.6 to 4.2 cm 3 ). The cortical-cancellous bone graft had an average length of 4.4 cm (4.1 to 5.0), a width of 0.8 cm (0.7 to 1.0), and an average thickness of 0.4 cm (0.3 to 0.6). Conclusion The technique for harvesting the olecranon graft is easy to perform, allowing a volume in average 3.9 cm 3 of cancellous graft and 4.4 cm and 0.8 cm of cortical-cancellous bone, for various upper limb defects, which require this need.
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