title: Complex reconstruction of the dorsal hand using the induced membrane technique associated with bone substitute: A case report.
abstract: BACKGROUND
  High-energy trauma of the hand often causes tissue loss involving bone, tendon and skin and is sometimes accompanied by devascularization of digits. Bone stabilization is the first step in the management of such injuries.
  
  
  METHODS
  A young patient presented composite tissue loss of the dorsum of his right (dominant) hand following an accident with a surface planer. Tissue loss involved the diaphyses of the first 4 metacarpals, tendons and skin with almost complete amputation of the 3rd finger. Bone stabilization comprised osteosynthesis using pins associated with cement to fill the bone defect. Hunter tendon rods were used for tendon repair and a pedicle groin flap (McGregor) was used to achieve skin coverage. The cement was replaced with autologous cortico-cancellous bone graft combined with bone paste (Nanostim) 3 months after the cement stabilization.
  
  
  RESULTS
  Eleven months after the accident, the patient was able to return to work as a carpenter. Pinch and Grasp strength in the injured hand were half that in the contralateral hand, but there was no loss of sensitivity. Mobility was very satisfactory with a Kapandji score of 9 and a mean TAM of 280°. The patient can write, open a bottle and does not feel limited for everyday activities. Radiographically, the bone of the 3 reconstructed metacarpals appears consolidated.
  
  
  CONCLUSIONS
  The induced membrane technique allowed the reconstruction of small bone deficits in the long bones of the hand in a two-step procedure, the first step taking place in an emergency context of composite tissue trauma.
authors.affiliation: Plastic and Reconstructive Surgery, 14 rue Paul Gaffarel, 21079 Dijon, France.
authors.forename: Vivien
authors.initials: V
authors.lastname: Moris
authors.affiliation: Plastic and Reconstructive Surgery, 14 rue Paul Gaffarel, 21079 Dijon, France.
authors.forename: David
authors.initials: D
authors.lastname: Guillier
authors.affiliation: Plastic and Reconstructive Surgery, 14 rue Paul Gaffarel, 21079 Dijon, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Rizzi
authors.affiliation: Plastic and Reconstructive Surgery, 14 rue Paul Gaffarel, 21079 Dijon, France.
authors.forename: Alice
authors.initials: A
authors.lastname: De Taddeo
authors.affiliation: Plastic and Reconstructive Surgery, 14 rue Paul Gaffarel, 21079 Dijon, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Henault
authors.affiliation: Plastic and Reconstructive Surgery, 14 rue Paul Gaffarel, 21079 Dijon, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Tchurukdichian
authors.affiliation: Plastic and Reconstructive Surgery, 14 rue Paul Gaffarel, 21079 Dijon, France.
authors.forename: Narcisse
authors.initials: N
authors.lastname: Zwetyenga
keywords: Bone defect; Bone substitutes; Hand trauma; Induced membrane