Name:
Vascularized Thumb Metacarpal Periosteal Flap (VTMPF) for Scaphoid Nonunion
Description:
Vascularized Thumb Metacarpal Periosteal Flap (VTMPF) for Scaphoid Nonunion
Thumbnail URL:
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Duration:
T00H08M21S
Embed URL:
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Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/055c9ac4-e05c-46ec-a97c-b6d31932a3ae/V-005695.mp4?sv=2019-02-02&sr=c&sig=ridVkxDrG%2FOfb2%2BpdeDh9L3L%2Bm9mBrGprOKo5Nyci%2B0%3D&st=2024-11-22T04%3A57%3A40Z&se=2024-11-22T07%3A02%3A40Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
FRANCISCO SOLDADO: Of the back of the first metacarpal for the treatment of recalcitrant trusses of the scaphoid. The authors have no relevant financial disclosure, no commercial support was provided. Male patient, 15 hears old, right handed, no previous medical conditions, no allergies, came to us with a fracture six months previous to our first evaluation.
FRANCISCO SOLDADO: The patient sustained an injury to the right hand as a result of a classic fall on a dorsiflexed hand. He was treated with immobilization, a cast and present a persistent wrist pain. Here's the post-cast control X-ray. We can see a semi-prothesis of the waist of the scaphoid, any slipped with bone loss and avascular necrosis of the proximal polar of the scaphoid.
FRANCISCO SOLDADO: For the pre-operative plan, we decide to perform a double approach for the polar approach of pseudoarthrosis and the dorsal approach for the first metacarpal to perform a vascularized periostic flap of the torso of the first metacarpal. Autologous bone graft of distal radius and stabilization with a retrograde cannulated screw.
FRANCISCO SOLDADO: The patient is placed in a supine position and ischemia is shown by elevation. As for the surgical technique, a better approach from its workers of scaffold on the flexor capsular release. Fibers and non-viable tissue was removed from the nonunion. We reduce and fix provisionally with two k-wires and put some out autologous cancellous. Bone graft harvested from the result radius to fill the gap and stabilize definitively using one headless compression screw.
FRANCISCO SOLDADO: Longitudinal dorsal approach is made, the nerve brands are identified and they are divided into the radial and ulna. The scudner frame is made and we are going to separate the EPB and the APL or radial and ulnar. Then we're going to get to the plane with the first dorsal metacarpal artery is seen which run through the Bowler part of the metacarpal attached to the abductor.
FRANCISCO SOLDADO: It's better to design the flap as distal as possible near to the metacarpophalangeal joint that gives you a longer pedicle. The distal part of the flap is dissected and [INAUDIBLE] distal vessels and the rest of the flap with a scalpel. You can go even to take a little fascia from the thumb abductor
FRANCISCO SOLDADO: and peel off the entire width of the flap. The periostic is, is raised. And with the periosteotome, you can use it to reattach the periosteum and you can go as far as you want. The flap designed that us,
FRANCISCO SOLDADO: he has been playing. The next step, once you get what you need, the periostic that you need is to perform the dissection to the supra periosteum plane. So you have to cut the periosteum here, now we're going to cut the periosteum and get into that supra periostic plane.
FRANCISCO SOLDADO: But, underneath the, the vessels of the superficial plane that you're going to see that first dorsal metacarpal artery. Here's, here's the artery when you.
FRANCISCO SOLDADO: You can see it these, from underneath this plan, this plane and you keep cutting. Supra periostively. You have to be very careful and dissect.
FRANCISCO SOLDADO: This part with precaution. Here we see the flap with the length of the pedicle plus the length of the flap. Then the ischemia cuff is lowered to check the correct vascularization of the flap. We see bleeding points in the periostic part and we observe that he's bleeding correctly.
FRANCISCO SOLDADO: Their average time to lift their flap is between 15 and 20 minutes. Tip to avoid having the flap backwards when you bring into the Buller side is to mark the non periostic part. You can see which part is the non periostic part?
FRANCISCO SOLDADO: Then you have to use two anchors for the stabilization, one on the proximal pole of the two and another in the [INAUDIBLE] scaphoid, suture the flap. Make sure that with the movement of the wrist, the flap does not come off. This is the result. This is the X ray, interpretive X-ray.
FRANCISCO SOLDADO: Now this is the pre-operative X-ray and now the post operative X-ray. After surgery, the wrist and thumb are immobilised in a spica plaster for two weeks. The patient is stimulated to start with the mobilization of the metacarpal phalangeal joint immediately. From two weeks, the stitches are removed and the patient is encouraged to perform passive flexion of the metacarpal carpometacarpal joint to avoid a stiffness innervation of the tendon.
FRANCISCO SOLDADO: A thermoplastic fibula is used of the six or seven weeks from then. Patient have to assist active and passive exercise and use the hand for activities of daily living. After 10 or 11 weeks, full movement is allowed. This is the last X-ray from April and the follow up is going well.
FRANCISCO SOLDADO:
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