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Triangular Vascularized Free Fibula Flap for Massive Carpal Reconstruction
David Graham1, Brahman Sivakumar2, Francisco Del Piñal3
1Department of Orthopaedic Surgery, Gold Coast University Hospital, Southport, Australia; Australian Research Collaboration on Hands (ARCH), Mudgeeraba, Australia; Griffith University School of Medicine, Southport, Australia.
Reconstructing massive carpal bone loss is challenging. This study presents a novel technique using a vascularized fibular flap and a management algorithm for metacarpal instability, offering new hope for patients.
Area of Science:
- Hand surgery
- Orthopedic reconstruction
- Microsurgery
Background:
- Massive carpal bone loss presents significant reconstructive challenges.
- Limited options exist, especially with metacarpal base involvement.
- Existing methods often yield suboptimal functional outcomes.
Purpose of the Study:
- To describe a novel technique for carpal reconstruction in cases of massive bone loss.
- To present a vascularized free fibular flap method incorporating closing wedge osteotomies.
- To propose an algorithm for managing associated metacarpal instability.
Main Methods:
- Utilized a triangular, vascularized free fibular flap.
- Incorporated closing wedge osteotomies within the fibular graft.
- Developed a stepwise algorithm for metacarpal stabilization and reconstruction.
Main Results:
- The described technique allows for reconstruction of the carpal architecture.
- Vascularized fibular flap provides robust bone stock for carpal reconstruction.
- The proposed algorithm aids in systematic management of complex cases.
Conclusions:
- This fibular flap technique offers a viable solution for massive carpal bone loss.
- The described method addresses both carpal defect and metacarpal instability.
- Further studies are warranted to evaluate long-term functional outcomes.
