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Three-dimensional virtual planning in precise chimeric fibula free flap for metacarpal defects: A case report
Hui Shen1, Xiang-Qian Shen, Ying Lv
1Department of Hand Surgery and Microsurgery Center, The First Affiliated Hospital, College of Medicine, ZheJiang University The Children's Hospital, Zhejiang University School of Medicine Department of Plastic Surgery, The First Affiliated Hospital, College of Medicine, ZheJiang University, HangZhou, ZheJiang Province, China.
Rationale:
Metacarpal and phalanx defects with soft tissue loss were suggested to be reconstructed by vascularized bone flap. The fibular osteocutaneous flap is a preferred method. Three-dimensional virtual planning has successfully applied in mandibular reconstruction with fibular free flap. We applied three-dimensional virtual planning in precise fibula flap harvest to maintain the continuity of the fibula and to achieve accurate metacarpal and phalanx reconstruction.
Patient Concerns:
A 35-year-old male presented with extensive soft tissue defects and first metacarpal defect involving the first metacarpophalangeal joint.
Diagnoses:
There were 4 cm of first metacarpal defect involving the first metacarpophalangeal joint and soft tissue defects of 5cm × 3cm + 3cm × 2cm.
Interventions:
By combining three-dimensional virtual planning, we harvested a chimeric fibular flap. The precise fibula partial osteotomies were performed with cutting guides designed in virtual planning.
Outcomes:
All the chimeric flaps survived and no significant donor-site morbidity was noted. Michigan Hand Outcome Questionnaire scores indicated acceptable functional results.
Lessons:
Our preliminary experience with the approach of three-dimensional virtual planning in precise chimeric fibula free flap is practical and efficient. Although more cases and follow-up are needed to evaluate it, this approach is expected to benefit patients.
