NECROSIS OF THE 1ST METACARPAL BONE IN A CASE OF ACUTE LYMPHATIC-LEUKEMIA IN CHILDHOOD

A 4-year-old girl suffering from acute lymphatic leukemia (ALL) was tr eated with cortisone and chemotherapy. During treatment a blister deve loped on the dorsum of her right hand, followed by a subsequent necros is of the underlying tissue and of the first metacarpal bone. Recurren t suppression of bone marrow prevented an immediate single step recons truction with a microvascular metatarsal bone transfer. Instead, the s oft tissue defect was first covered with a pedicled groin flap and the skeleton of the thumb was supported with an external fixator. Then, a free fibular bone graft was transferred. During a complete remission of ALL, a microvascular transfer of the metatarsal bone and joint was finally performed. Two years after reconstruction the right hand is st ill the dominant one and both thumbs grow proportionately.