Acta chirurgiae orthopaedicae
et traumatologiae Čechoslovaca

Acta Chir Orthop Traumatol Cech. 2019; 86(4):290-293 | DOI: 10.55095/achot2019/049

Vascularised Fibula and Tendon Transfer in the Comprehensive Treatment of Forearm Fracture with Gas Gangrene ComplicationCase report

D. PALENČÁR^1,2,*, A. ŠVEC^1,2

¹ Klinika plastickej, rekonštrukčnej a estetickej chirurgie Lekárskej fakulty Univerzity Komenského v Bratislave a Univerzitnej nemocnice Bratislava

² I. ortopedicko-traumatologická klinika Lekárskej fakulty Univerzity Komenského v Bratislave a Univerzitnej nemocnice Bratislava

Vascularized bone grafting was for the first time described in the 1970s. It has become a crucial component in the reconstruction of long bone defects and non-unions in a poorly vascularised environment. Although the vascularized bone is well described for the lower extremity and mandibular reconstructions, it started to be used for the upper extremity bone defects only recently.
This publication presents a case of a young man with an open fracture of both the forearm bones. The treatment of the injury has been complicated with anaerobic gas gangrene of the forearm. This resulted in a non-union, radius shortening and necrosis of both the thumb extensors and flexors muscles. Once the acute infection was managed, the patient received a two-step treatment provided jointly by orthopaedic and plastic surgeons at the University Hospital in Bratislava. At the first stage auto transplantation of the vascularized fibula into the defect of radius was performed, with radial artery and radial veins being the recipient vessels. One year later, a tendon transfer was made in order to reconstruct the extension and flexion of the thumb. Donor tendons were the following: extensor indicis proprius and flexor digitorum superficialis for ring finger. The result of the reconstruction is the full incorporation of the fibular transplant (6 months after the primary operation) and the excellent range of motion of the hand and wrist. Thanks to the tendon transfer the function of the thumb, including the opposition, was achieved two months after the secondary surgery.

Keywords: defect of radius, tendon transfer, anaerobic infection, gas necrosis, microsurgery

Published: August 1, 2019  Show citation