title: Primary bone grafting with pedicled flap cover for dorsal combined injuries of the digits.
abstract: Twenty digits in 15 patients with dorsal combined tissue loss were treated by radical debridement, primary non-vascularised iliac crest bone graft and immediate lower abdominal flap cover between 1996 and 2006. The average length of the bone grafts was 3.3 (range 2.5-5) cm. No extensor tendon reconstruction was carried out. The flaps were divided at 3 weeks without delay. Permissible thinning of the flap was done at the time of division of flaps. No secondary procedure was done. All patients were retrospectively reviewed and X-rays obtained. Radiological union was achieved in 18 of 20 digits. One bone graft was removed because of infection. One bridging bone graft united with the distal phalanx but had a painless non-union with the proximal phalanx. There were no flap complications. Bone graft length resorptions of 20% and 15% occurred in two terminal bone grafts. We recommend this protocol as a solution to this challenging problem.
authors.affiliation: Department of Plastic, Hand and Reconstructive Microsurgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India. rajahand@vsnl.com
authors.forename: S R
authors.initials: SR
authors.lastname: Sabapathy
authors.forename: H
authors.initials: H
authors.lastname: Venkatramani
authors.forename: T
authors.initials: T
authors.lastname: Giesen
authors.forename: A S
authors.initials: AS
authors.lastname: Ullah
mesh_terms: D000293:Adolescent; D000328:Adult; D016025:Bone Transplantation; D003646:Debridement; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013524:Surgical Flaps