Гений oртопедии (Jun 2024)

New finger reconstruction technologies using 3D printing

  • Nikolay M. Alexandrov,
  • Ivan D. Veshaev

DOI
https://doi.org/10.18019/1028-4427-2024-30-3-427-437
Journal volume & issue
Vol. 30, no. 3
pp. 427 – 437

Abstract

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Introduction The use of 3D printing technology in finger reconstruction improves accuracy of the procedure minimizing the donor defect and optimizing the appearance and function of the finger. The use of this technology in the finger reconstruction with an osteocutaneous radial forearm flap with axial blood supply and lengthening of the digital stumps and metacarpals remains poorly explored. The objective of the study was to demonstrate new methods of preoperative planning for finger reconstruction and improve surgical outcomes. Material and methods Outcomes of five patients treated with original methods based on 3D technology were retrospectively evaluated during preoperative planning, reconstruction of the thumb using an osteocutaneous radial forearm flap with axial blood supply, relocation of the stump of the third finger and lengthening of the stumps of the first and second metacarpals. The patients could achieve consolidation of interpositional bone allografts following lengthening of the finger stumps, stability of the bone base of the finger, organotypic restructuring of the marginal allograft during plastic surgery with an osteocutaneous radial forearm flap, and a functional position of the reconstructed thumb using the middle finger stump. Results and discussion An individual device for planning finger reconstruction allows identification of the optimal size and position of the finger in three planes, which is essential for patients with severe hand deformities to avoid corrective procedures. An individual guide was used to osteotomize the radius to harvest a vascularized graft providing a cutout of a given size and shape and a cortical-cancellous allograft being identical in shape and size to replace the donor bone defect. The combined use of Masquelet technology and distraction of the finger stump or a metacarpal improved conditions for consolidation and restructuring of the interpositional allograft preventing fractures and infection. Conclusion The use of 3D technology in finger reconstruction using an osteocutaneous radial forearm flap with axial blood supply and distraction of the finger stumps and metacarpals can improve surgical outcomes.

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