Necrosis of the first metacarpal bone in a case of acute lymphatic leukemia in childhood.
A 4-year-old girl suffering from acute lymphatic leukemia (ALL) was treated with cortisone and chemotherapy. During treatment a blister developed on the dorsum of her right hand, followed by a subsequent necrosis of the underlying tissue and of the first metacarpal bone. Recurrent suppression of bone marrow prevented an immediate single step reconstruction with a microvascular metatarsal bone transfer. Instead, the soft tissue defect was first covered with a pedicled groin flap and the skeleton of the thumb was supported with an external fixator. Then, a free fibular bone graft was transferred. During a complete remission of ALL, a microvascular transfer of the metatarsal bone and joint was finally performed. Two years after reconstruction the right hand is still the dominant one and both thumbs grow proportionately.
Deutinger
M
M
Abteilung für Plastische Chirurgie, 2. Chir. Univ.-Klinik Wien.
Vollnhofer
G
G
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D016025:Bone Transplantation; D002675:Child, Preschool; D003348:Cortisone / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008663:Metacarpus / Q000473:pathology*; D010020:Osteonecrosis / Q000139:chemically induced* / Q000601:surgery; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy*; D013524:Surgical Flaps
D003348:Cortisone