Staged and late-period reconstruction of the crushed hand: prefabricated osseous flap.

The principle of controlled utilization of increased vascularity in the regions of artificially established ischemia constituted the basis of prefabrication of the vascular induction through staged transfers. We have used this principle, and a part of a metacarpal bone was prefabricated with an artery. The artery was inserted into the bone, and a defect was repaired with this prefabricated osseous flap; meanwhile, another defect was amended with a bone graft. The static bone scintigraphy of the hand at the 6-month postoperative stage indicated evident superiority of the vascularity of the prefabricated osseous flap at the ring finger when compared with the bone graft at the middle finger. The angiography demonstrated a high vascular pattern of the flap at its location at the proximal phalanx of the ring finger. The structures that remained healthy after the injury either on the amputated side or on the hand could be used in reconstruction. The tendinous and osseous structures could be used as free grafts, and the vascular structures could be transferred as vascular pedicles, allowing the creation of previously nonexistent flaps and composite tissues that were ideal for reconstruction. Any tissue possessing a vascular supply could be used as a vascular crane in any prefabrication process.