| Objective To explore the early clinical effect of antibiotic cement pretreatment combined with delayed primary ilioinguinal free flap for open multiple metacarpal fractures.Methods From July 2019 to July 2022, 16 patients with open multiple metacarpal fractures and soft tissue defects in the hand were treated in the Fourth People's Hospital of Guiyang. Emergency debridement fractures were fixed with Kirschner wires combined with mini-plate to repair damaged tendons, blood vessels, and nerves. The ilioinguinal free flap was used to repair the wound on the back of the hand after 5-7 d. Patients ranged in age from 26 to 62 years, with a mean age of 46 years. The area of the soft tissue defect ranged from 5.0 cm×9.0 cm to 7.0 cm×15.0 cm, including 12 cases of tendon rupture (without tendon defect), 10 cases of major vascular and nerve injury, 2 cases of fracture and dislocation of the metacarpophalangeal joint. After thorough emergency debridement, antibiotic-loaded bone cements were applied to cover the wound surface for 5-7 d, and then covered with ilioinguinal free flap. After the operation, regular follow-up visits were conducted at the specialist clinic, WeChat, and telephone to observe the appearance of the flap and the function of the fingers.Results Postoperative follow-up ranged from 8 to 24 months, with an average of 14 months. After surgery, all the fractures healed initially, 16 cases of flap had fully survived and 1 case developed superficial infection, which healed after dressing change. It was observed that the flap had varying degrees of pigmentation, the appearance was not bloated, the texture was soft to touch, the donor site healed well, and no functional or sensory disorders. The average active range of motion of the metacarpophalangeal joint in the last follow-up was from (10±10)° to (60±15)°, and the active range of motion of the distal and proximal interphalangeal joints was normal, and according to the trial standard of the upper limb functional assessment of the Chinese Medical Association, excellent in 9 cases, good in 6 cases, and poor in 1 case.Conclusion Pretreatment with antibiotic cement combined with delayed primary ilioinguinal free flap for open multiple metacarpal fractures has the advantages of low infection rate, the flap donor site is more concealed, and the recent clinical efficacy is satisfactory. |
