Extensive limb-sparing surgery with reconstruction for sarcoma of the hand and wrist

Abstract

IV, retrospective study.

Primary tumors of the hand: Functional and restorative management

“…Restoration of sensibility is especially important in reconstruction of sensitive areas such as the thumb pulp. The sural nerve is preferred for nerve grafting due to its low morbidity . Vascularized sural nerve graft offers the advantages of containing an immediate blood supply, reducing the risk of intraneural fibrosis by avoiding a required period of revascularization, and of promoting rapid axonal regeneration compared with nonvascularized nerve grafting .…”

“…If defects following tumor resection are relatively small in size, the iliac crest can provide a rich source of cortico‐cancellous bone graft material. For example, an iliac bone graft can be used to replace the first, fourth, and fifth metacarpal bones, as well as the thumb phalanges . It can also be combined with a free neurovascular flap in a single‐stage operation to reconstruct bone and soft tissue of the proximal phalanges, the metacarpophalangeal joints, or the carpometacarpal joint .…”

“…However, postoperative radiographical monitoring is required to evaluate bony union and the possibility of post‐radiation cartilage degeneration or bone absorption . If tumor resection requires removal of the distal radius in children with active growth plates, the free fibular flap can be utilized or modified to provide the vascularized fibular head supplied by the anterior tibial artery …”

“…Hunter et al described a two‐stage flexor tendon reconstruction using a silicone rod implant in the first stage and a free tendon graft through the pseudosheath formed around the silicone in the second stage . Several applications and modifications of these techniques have been described . The two‐stage Hunter technique has been applied to carpal tunnel reconstruction, using a palmaris longus graft for the extensor carpi radialis brevis and extensor carpi radialis longus, extensor indicis proprius graft for the extensor pollicis longus, and hemi‐flexor carpi radialis graft for the abductor pollicis longus …”

“…Several applications and modifications of these techniques have been described . The two‐stage Hunter technique has been applied to carpal tunnel reconstruction, using a palmaris longus graft for the extensor carpi radialis brevis and extensor carpi radialis longus, extensor indicis proprius graft for the extensor pollicis longus, and hemi‐flexor carpi radialis graft for the abductor pollicis longus …”