Journal of Hand and Microsurgery最新文献

{"title":"Dissecting neural anomalies and clinical impact of aberrant median and ulnar nerve pathways in the forearm: A systematic review and meta analysis.","authors":"O R Jeff Walter Rajadurai, P A Prem Regis, S Supadevi, S Vinoth","doi":"10.1016/j.jham.2026.100446","DOIUrl":"10.1016/j.jham.2026.100446","url":null,"abstract":"<p><p>Aberrant communications between the median and ulnar nerves in the forearm and hand are clinically important anatomical variants that can significantly influence electrophysiological interpretation and surgical decision-making. This systematic review and meta-analysis aimed to synthesize available anatomical and electrophysiological evidence on the prevalence, subtypes, and clinical implications of median-ulnar nerve anastomoses, including Martin-Gruber, Marinacci, Riche-Cannieu, and Berrettini connections. A comprehensive search of major databases identified 20 eligible studies encompassing electrophysiological, anatomical, and clinical designs. Meta-analysis was performed using event-rate methodology with logit transformation under a random-effects model. The pooled prevalence of Martin-Gruber anastomosis (MGA), derived from six studies, was approximately 21%, indicating that nearly one in five individuals demonstrates median-to-ulnar nerve communication in the forearm. Subgroup analysis revealed a higher prevalence in healthy populations (≈25%) compared with carpal tunnel syndrome (CTS) populations (≈8-10%), suggesting that median nerve compression may obscure electrophysiological detection of MGA. Cadaveric studies reported lower detection rates (≈6%), reflecting methodological differences. Subtype analysis demonstrated that Type II MGA was more prevalent than Type I, with pooled prevalence estimates of approximately 62% and 31%, respectively, highlighting substantial anatomical variability. Considerable heterogeneity was observed across subgroup analyses, reflecting differences in population characteristics and electrophysiological protocols. Beyond MGA, Marinacci anastomosis was uncommon (≈0.7-4%), whereas Riche-Cannieu and Berrettini anastomoses were frequent, with reported prevalences exceeding 50% in anatomical and electrophysiological studies. Clinically, these variants are highly relevant, as unrecognized nerve communications may lead to pseudo-conduction block, mislocalization of neuropathies, underestimation of CTS severity, and iatrogenic injury during forearm or hand surgery. These findings underscore the necessity of incorporating anatomical awareness and targeted electrophysiological strategies into routine clinical practice.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 3","pages":"100446"},"PeriodicalIF":0.7,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13059007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147647003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical treatment of hourglass-like nerve constrictions with allogeneic nerve: a series report of 4 cases.","authors":"Minghua Zhao, Cuiping Cao, Meng Wang, Haixia Wang, Haixin Zhang, Yifan Wang, Jian Zhao, Xuyin Gong","doi":"10.1016/j.jham.2026.100447","DOIUrl":"10.1016/j.jham.2026.100447","url":null,"abstract":"<p><strong>Purpose: </strong>Hourglass-like constriction (HGC) is an anatomical finding of peripheral nerves, most commonly associated with immune-mediated inflammatory neuropathies such as neuralgic amyotrophy. Current treatment modalities primarily include conservative observation, neurolysis, autologous nerve grafting, and tendon transfer. Allogeneic nerves, as alternative graft materials for nerve reconstruction, have not been systematically reported in the management of hourglass-like constrictions. This study aimed to report the clinical outcomes of allogeneic nerve reconstruction in carefully selected cases of allogeneic nerve transplantation for treating multi-segmental radial nerve hourglass constrictions.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 4 patients (3 males, 1 female) with idiopathic radial nerve palsy treated in our department from February 2019 to February 2022. All cases presented with severe multi-segmental constrictions. Preoperative evaluation included electromyography and high-frequency ultrasound to assess nerve damage. Intraoperatively, constricted segments were completely resected, and allogeneic nerve grafts were used for reconstruction. Postoperative follow-up duration ranged from 18 to 26 months (mean 22 months).</p><p><strong>Results: </strong>All incisions healed primarily without clinically apparent immune rejection or infection. Motor function was evaluated using the British Medical Research Council (BMRC) muscle strength grading scale, combined with electromyography for nerve regeneration assessment. At 18 months postoperatively, all patients achieved significant recovery of active thumb and finger extension: 3 patients demonstrated M4 strength in extensor pollicis longus and extensor digitorum communis, while 1 patient showed M3 for extensor pollicis longus and M4 for extensor digitorum communis.</p><p><strong>Conclusion: </strong>For severe multi-segmental hourglass-like constrictions, resection combined with nerve grafting is recommended. Allogeneic nerve transplantation may represent a safe and effective treatment option in selected cases of radial nerve hourglass constrictions. However, further large-scale randomized controlled trials are required to validate its long-term efficacy in repairing long-segment, thick mixed nerve defects.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 3","pages":"100447"},"PeriodicalIF":0.5,"publicationDate":"2026-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13019915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147575808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Amandys® pyrocarbon interposition wrist arthroplasty: a systematic review of clinical outcomes and complications.","authors":"Francesco Smeraglia, Lucian Lior Marcovici, Morena Anna Basso, Alessio Bernasconi, Andrea Cozzolino, Giovanni Balato","doi":"10.1016/j.jham.2026.100442","DOIUrl":"10.1016/j.jham.2026.100442","url":null,"abstract":"<p><strong>Background: </strong>Pyrocarbon interposition arthroplasty (Amandys®) has been proposed as a motion-preserving salvage procedure for advanced wrist degeneration. However, its clinical outcomes, complication profile, and role within the contemporary wrist salvage algorithm remain incompletely defined.</p><p><strong>Objective: </strong>To systematically review the clinical outcomes, complications, and revision patterns associated with Amandys® pyrocarbon interposition wrist arthroplasty, without performing a direct comparative analysis with other wrist salvage procedures, and to clarify its role among current treatment options.</p><p><strong>Materials and methods: </strong>A systematic review of the literature was conducted using PubMed, Scopus, and Web of Science databases. The search term \"Amandys\" was used without additional filters. Clinical studies reporting outcomes of Amandys® wrist arthroplasty were included. Data extraction focused on study characteristics, clinical outcomes, complications, and revision procedures. Methodological quality was assessed using the Coleman Methodology Score.</p><p><strong>Results: </strong>Ten clinical studies met the inclusion criteria, comprising a total of 224 wrists treated with Amandys® interposition arthroplasty. Pain reduction and improvement in patient-reported outcome measures were consistently reported across studies, with preservation of wrist range of motion. Complication rates were substantial, with approximately one fifth of wrists experiencing postoperative complications and nearly one fifth requiring reoperation. Most secondary procedures were related to early mechanical instability and consisted of technically oriented revisions rather than implant removal. Conversion to total wrist arthrodesis occurred less frequently. The overall methodological quality of the included studies was moderate.</p><p><strong>Conclusion: </strong>Amandys® pyrocarbon interposition arthroplasty provides clinical improvement and preserves wrist motion but is associated with a relevant and less predictable rate of complications and reoperations. When feasible, proximal row carpectomy remains the preferred motion-preserving procedure. Amandys® arthroplasty should be regarded as a highly selective salvage option, particularly in patients unsuitable for proximal row carpectomy-based solutions, with careful patient selection being essential to optimize outcomes.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 3","pages":"100442"},"PeriodicalIF":0.7,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12969408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147436467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pedicled distal-radius vascularized bone graft with shape-memory staple fixation for scaphoid nonunion: A modified technique.","authors":"Andrea Cruciani, Silvia Pietramala, Alessio Greco, Lorenzo Rocchi, Gianfranco Merendi, Camillo Fulchignoni","doi":"10.1016/j.jham.2026.100443","DOIUrl":"10.1016/j.jham.2026.100443","url":null,"abstract":"<p><p>Scaphoid nonunion remains a challenging condition due to the scaphoid's retrograde vascular supply, its susceptibility to collapse, and the risk of progressive carpal malalignment and degenerative changes. Pedicled vascularized bone grafts harvested from the distal radius preserve intrinsic perfusion but require stable fixation to allow graft incorporation. This study describes a modified surgical technique combining a pedicled distal-radius vascularized bone graft based on the recurrent volar intercarpal artery with fixation using a shape-memory nitinol compression staple and reports early clinical and radiographic outcomes in a consecutive series. A retrospective analysis of 8 consecutive patients treated between January 2024 and January 2025 was performed. Clinical outcomes included wrist range of motion, pain assessed using a visual analog scale (VAS), the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and the Michigan Hand Outcomes Questionnaire (MHQ). Radiographic union was evaluated using standard radiographs and computed tomography (CT). Bony union was achieved in all patients (100%) by six months. Mean QuickDASH scores improved from 36 preoperatively to 6 at final follow-up, while mean MHQ scores improved from 60 to 91. Mean clinical follow-up was 7 months. No implant-related complications or donor-site morbidity were observed. This modified technique appears feasible and was associated with early radiographic union and functional improvement in this small retrospective series. However, these findings represent preliminary results, and larger comparative studies with longer follow-up are required to determine its long-term clinical effectiveness and potential advantages over established fixation methods.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 3","pages":"100443"},"PeriodicalIF":0.7,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12969401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of infected flexor tendon injuries: A narrative review.","authors":"Lamisah Seedat, Papa Kyei, Tatolo Sefeane, Mohamed Bhamjee, Grant Biddulph","doi":"10.1016/j.jham.2026.100441","DOIUrl":"10.1016/j.jham.2026.100441","url":null,"abstract":"<p><strong>Purpose: </strong>Flexor tendon injuries are a common result of trauma to the hand. The mechanisms of injury often result in open wounds with contamination and infection. The complications associated with infected wounds pose challenges to flexor tendon repair. Management entails adequate eradication of infection and tissue healing prior to tendon repair. Whilst guidelines exist for the management of flexor tendon injuries of the hand, the literature puts little emphasis on the management of these cases with the presence of concomitant infection. Creating clear outlines to adequately manage such cases would aid future management for optimal outcomes.</p><p><strong>Methods: </strong>A comprehensive search of literature was conducted. Articles published in English within the last 20 years were used.</p><p><strong>Results: </strong>Wounds with macroscopic wound contamination should receive empiric antibiotics. There is little evidence supporting prophylactic antibiotics. Pyogenic flexor tenosynovitis should be immediately taken to theatre. If possible, primary tendon repair is the ideal method of repair, however this is often limited by infection. The choice of secondary reconstruction depends on timing and extent of injury. If there is loss of nerve function, a tendon transfer is required. Tendon grafts are used in cases of loss of tendon length. A damaged tendon sheath requires two-stage tendon reconstruction.</p><p><strong>Conclusion: </strong>Infected wounds are a common complicating presenting factor in flexor tendon injuries. Empiric antibiotics in complex and contaminated wounds is essential. Primary tendon repairs have the best outcomes, however repair should be withheld until granulation tissue develops. Secondary repair options should be looked at on a case-specific basis.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 3","pages":"100441"},"PeriodicalIF":0.7,"publicationDate":"2026-02-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12933450/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147311170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-reported pain and hand function: important determinants of the postoperative results one year after PIP arthroplasty.","authors":"Bo J W Notermans, Joris S Teunissen, Ruud W Selles, Luitzen H L de Boer, Brigitte E P A van der Heijden","doi":"10.1016/j.jham.2026.100421","DOIUrl":"10.1016/j.jham.2026.100421","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to assess determinants associated with patient-reported pain and hand function 12 months after proximal interphalangeal joint arthroplasty for osteoarthritis.</p><p><strong>Methods: </strong>Prospectively gathered data of 113 patients, who completed the Michigan Hand outcomes Questionnaire preoperatively and 12 months postoperatively, was used. We compared pre- and 12-month postoperative (categorized) MHQ pain and hand function scores and assessed determinants associated with the postoperative scores.</p><p><strong>Results: </strong>The Michigan Hand outcomes Questionnaire pain and hand function scores at intake were 41 (SD 19) and 52 (SD 17), respectively, and 65 (SD 23) and 63 (17) after surgery. Less pain at intake was associated with less pain 12 months postoperatively. The following determinants were associated with better hand function after surgery: better hand function at intake, surgery on the dominant hand, and the use of surface replacement implants.</p><p><strong>Conclusion: </strong>MHQ scores at intake were significantly associated with postoperative MHQ scores. This knowledge can be used during preoperative consultation to improve shared decision making and create adequate patients' expectations.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 2","pages":"100421"},"PeriodicalIF":0.7,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12874284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146144148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research status of diagnosis and treatment of varus-posteromedial rotatory instability of the elbow joint.","authors":"Guang-Yu Wang, Ji-Nan Hu, Rong-Kuan Zhai, Mai Mai Ti Yiming Mai Tu di, Xu Tian, Jing-Ming Dong","doi":"10.1016/j.jham.2025.100399","DOIUrl":"10.1016/j.jham.2025.100399","url":null,"abstract":"<p><strong>Background: </strong>Varus-posteromedial rotatory instability (VPMRI) of the elbow is a relatively uncommon yet significant injury that can often present with subtle clinical symptoms, such as mild joint misalignment. These initial symptoms may be easily overlooked or misdiagnosed, especially in the absence of overt signs of instability. As a result, the injury is frequently missed in early stages, leading to improper or delayed treatment. If left untreated, VPMRI can result in severe long-term complications, including rapid joint degeneration, traumatic arthritis, heterotopic ossification, elbow stiffness, and ulnar nerve entrapment. The progressive nature of these issues can lead to permanent functional impairment and reduced quality of life.</p><p><strong>Methods: </strong>A comprehensive literature review was performed to investigate the study objective.</p><p><strong>Results: </strong>By examining both conservative and surgical interventions, the review provides a comprehensive understanding of this injury, emphasizing the importance of early diagnosis and appropriate management. Understanding the specific forces involved, such as axial loading, varus stress, and forearm pronation, is crucial for developing effective treatment strategies.</p><p><strong>Conclusion: </strong>Early intervention can prevent long-term complications and improve functional outcomes, making timely and accurate diagnosis essential for optimal care.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 2","pages":"100399"},"PeriodicalIF":0.7,"publicationDate":"2025-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12804368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconstruction of the amputated thumb using great toe transfer and dual bone lengthening technique with an Ilizarov mini-fixator.","authors":"Hiroyuki Gotani, Yusuke Miyashima, Thanat Charoenpol, Kosuke Sasaki, Hirohisa Yagi, Sopinun Siripoonyothai, Jun Tsujimoto, Haato Kimura, Yuji Murakami, Takashi Tsuchiya","doi":"10.1016/j.jham.2025.100394","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100394","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to introduce the thumb reconstruction technique both by microsurgical reconstruction using a great toe transfer and dual bone lengthening technique with an Ilizarov mini-fixator for the fingers.</p><p><strong>Methods: </strong>The great toe was transferred to the amputated thumb, followed by a bone lengthening procedure for the residual metacarpal bone to enable easy pinching. During the metacarpal bone lengthening, osteotomy was performed at two sites to shorten the period of bone fusion.</p><p><strong>Results: </strong>The great toe transfer was performed successfully and metacarpal bone fusion was achieved earlier than usual by dual osteotomy technique, allowing the patients to eventually resume their previous jobs.</p><p><strong>Conclusion: </strong>Our procedure reported herein, i.e., great toe transfer by microsurgery + dual osteotomy distraction lengthening, seems to serve as a useful procedure for thumb reconstruction from both cosmetic and functional improvement.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100394"},"PeriodicalIF":0.5,"publicationDate":"2025-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12796925/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nerve injuries following reconstructive and cosmetic breast surgery: A systematic review and meta-analysis.","authors":"John D Nguyen, Alec J Chen, Jeffrey Khong, Isabel A Snee, Myiah Quach, Ala Elhelali, Sami H Tuffaha, A Lee Dellon","doi":"10.1016/j.jham.2025.100396","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100396","url":null,"abstract":"<p><strong>Background: </strong>Breast surgery carries the risk of intercostal nerve injuries, with symptoms ranging from sensory disturbances to chronic pain. This study characterizes post-operative intercostal nerve injuries following breast surgery and available microsurgical management options.</p><p><strong>Methods: </strong>A systematic review was conducted using PubMed, Embase, Web of Science, and Scopus for the years 2003-2024. The primary inclusion criteria was a patient experiencing any neuropathic symptoms (defined as pain or sensory changes) following mastectomy, breast reconstruction, or aesthetic breast surgery.</p><p><strong>Results: </strong>Of 514 unique studies, 39 (n = 9083 patients) were included. The procedures included breast augmentation (n = 6291, 69.3 %), mastectomy without reconstruction (n = 1701, 18.7 %), mastectomy with reconstruction (n = 654, 7.2 %), and breast reduction (n = 434, 4.9 %). After these procedures, 1144 (12.6 %) patients experienced chronic pain and 135 (1.8 %) had nerve injuries, consisting of intercostal nerves (n = 133, 98.5 %) or brachial plexus nerves (n = 2, 1.5 %). Of patients with nerve injuries, 23 (9.2 %) underwent surgical interventions, which included neurectomy (n = 11, 47.8 %), neuroma excision (n = 10, 43.5 %), implant removal (n = 8, 34.8 %), and dorsal rhizotomy (n = 1, 4.3 %).</p><p><strong>Conclusion: </strong>This study demonstrates a substantial risk of chronic pain and peripheral nerve injuries following breast surgery. The low utilization of surgical options (4.6 %) may indicate limited patient unawareness of the pain relief which microsurgical intervention offers when conservative approaches fail in reduction or resolution of symptoms.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100396"},"PeriodicalIF":0.5,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12757640/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145901166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascularized iliac crest reconstruction of the distal fibula after trauma: Technical notes and long term follow up.","authors":"Pierluigi Tos, Davide Ciclamini, Alessandro Crosio, Valentina Cecconato, Bruno Battiston","doi":"10.1016/j.jham.2025.100393","DOIUrl":"https://doi.org/10.1016/j.jham.2025.100393","url":null,"abstract":"<p><strong>Background: </strong>Large post-traumatic defects of the lateral malleolus are uncommon but present major reconstructive challenges, particularly in the presence of segmental bone loss, infection, or soft-tissue compromise. The lateral malleolus is essential for ankle stability, and its absence leads to mechanical imbalance and early degenerative changes. Traditional solutions-including non-vascularized grafts, allografts, arthrodesis, or fibular transfers-may be inadequate when biological conditions are poor or when three-dimensional reconstruction is required. Vascularized bone flaps offer improved union rates and enhanced resistance to infection. The vascularized iliac crest flap, although well-established in limb reconstruction, remains infrequently reported for distal fibula restoration.</p><p><strong>Methods: </strong>Three patients with severe post-traumatic lateral malleolar defects were treated between 2002 and 2015 at two microsurgical centers. Reconstruction was performed using free vascularized iliac crest flaps based on the deep circumflex iliac artery. Flap configuration (osteo-muscular or osteo-cutaneous) was adapted to defect size and soft-tissue requirements. Technical details-including flap harvest, shaping of the iliac crest segment, fixation, and vascular anastomoses-are described. Clinical and radiographic outcomes were evaluated over 8-14 years.</p><p><strong>Results: </strong>All flaps survived without major postoperative complications. Radiographs demonstrated consistent osseous union between the iliac crest graft and tibia. All patients achieved full weight-bearing and stable ankle function. Mild-to-moderate radiographic osteoarthritis occurred at long-term follow-up but remained asymptomatic. Soft-tissue coverage was reliable, and no secondary flap procedures were required.</p><p><strong>Conclusions: </strong>The free vascularized iliac crest flap is a dependable and versatile reconstructive option for extensive lateral malleolar defects. It provides stable ankle restoration, predictable union, and durable function, and should be considered when conventional grafting or fibular transfers are unsuitable, particularly in complex post-traumatic or infected environments.</p>","PeriodicalId":45368,"journal":{"name":"Journal of Hand and Microsurgery","volume":"18 1","pages":"100393"},"PeriodicalIF":0.5,"publicationDate":"2025-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12768900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}