Use of a Reverse Metacarpal Bone Flap for the Treatment of Segmental Bone Defects of the Proximal Phalanges

Purpose The purpose of this retrospective study was to report the results of reconstruction of segmental bone defects of the proximal phalanges using a reverse metacarpal vascularized bone flap harvested from the third metacarpal bone. Methods From August 2012 to May 2017, 17 patients with segmental osteomyelitis or necrotic bone of the proximal phalanges were treated. There were 15 male and 3 female patients, with a mean age of 36 years (range, 19–65 years). The mean size of bone defects was 26 × 9 × 9 mm (range, 16 × 6 × 7 mm to 35 × 10 × 7 mm); and the mean size of bone flaps was 27 × 8 × 7 mm (range, 15 × 7 × 4 mm to 40 × 8 × 7 mm). Results The mean follow-up period was 26 months. The mean motion arc of the metacarpophalangeal joints was 56° (range, 22°–90°). The mean pinch strength of the injured fingers was 3.1 kg (range, 2–3.6 kg), and the mean pinch strength of the normal contralateral side was 6.9 kg (range, 4.2– 8.5 kg). Conclusions The reverse metacarpal bone flap may promote osseous healing in reconstructing segmental defects of the proximal phalanges. Type of study/level of evidence Therapeutic IV.