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.
Abteilung für Plastische Chirurgie, 2. Chir. Univ.-Klinik Wien.
M
M
Deutinger
G
G
Vollnhofer
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