|| FIG. 15-44. X ray shows defect at the base of the second, third, fourth, and fifth metacarpals with loss of most of the distal carpal row. Intermedullary spacers are in place to preserve bone length.
FIG. 15-45. A large block of bone has been completely isolated and transplanted to the hand. The superficial and deep circumflex iliac systems can be seen coming off the skin island and bone island.
FIG. 15-46. The bone block has been tailored and pinned in place with multiple longitudinal K-wires through the metacarpals and across the wrist, as shown in x ray.
FIG. 15-47. Dorsal view of the healed osteocutaneous flap with some redundancy of the skin flap.
FIG. 15-48. Good flexion of the fingers with restoration of grip function. The extensor tendons were reconstituted with silicone rods and tendon grafts placed underneath the cutaneous flap after bony healing was completed.
This case depicts the management of a compound comminuted fracture with exposed segments of bone.
FIG. 15-49. The fracture is shown one month postinjury.
FIG. 15-50. X ray of the original injury shows the double bone fracture with a large butterfly fragment displaced.
FIG. 15-51. Close-up of the wound status. The butterfly fragment is in place, but the exposed separate segment is devitalized.
FIG. 15-52. The devitalized bone and exposed wires were debrided and the defect filled with a vascularized DCIA osteocutaneous flap.
FIG. 15-53. Skin paddle inset over vascularized bone graft.
FIG. 15-54. X ray shows the healed segment 3 years post-injury. An additional fibular graft from the same leg was necessary to give strength to the cancellous iliac graft.
FIG. 15-55. Patient is fully ambulatory with good protective cover over the bone grafts.