Arch Hand Microsurg.  2019 Dec;24(4):408-415. 10.12790/ahm.2019.24.4.408.

Free Posterior Interosseous Artery Flap for Treatment of First Web Space Contracture: Methods of Venous Anastomosis

• Fujiwara M
• Matsushita Y
• Maeba Y
• Suzuki A
• Fukamizu H
• Tokura Y

• KMID: 2464479
• DOI: http://doi.org/10.12790/ahm.2019.24.4.408

Abstract

PURPOSE
First web space widening is crucial in the hand function. The skin on the dorsal side of the forearm can provide a thin and pliable skin suitable for first web space reconstruction. Although previous reports have described the use of the posterior interosseous artery (PIA) flap as a reverse-flow flap for treatment of first web space contracture, only a few have addressed its use as a free flap for this purpose. The caliber of the concomitant veins accompanying the PIA is usually small, which may give rise to a problem in the treatment.
METHODS
Seven patients with first web space contracture were treated with a free PIA flap and the details of the venous anastomosis method were elucidated.
RESULTS
Six of seven flaps survived. In a post-burn case, a flap was lost by late thrombosis. The PIA is anastomosed end-to-end to the dorsal branch of the radial artery. There are two choices for the recipient venous pedicle: concomitant veins of radial artery and a tributary of the cephalic vein. In our cases, there were four types of venous anastomosis. An average postoperative increase of the thumb radial abduction was 36° and that of the palmar abduction was 35°.
CONCLUSION
Since the caliber of the concomitant veins accompanying the PIA is small, a careful scheme for venous anastomosis is essential in the treatment of first web space contracture using the free PIA flap.

Keyword

Free posterior interosseous artery flap; First web space contracture; Venous anastomosis

MeSH Terms

Arteries*
Contracture*
Forearm
Free Tissue Flaps
Hand
Humans
Methods*
Radial Artery
Skin
Thrombosis
Thumb
Veins

Figure

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  Fig. 1. (A) Preoperative palmar view. (B) Preoperative lateral view. (C) Free posterior interosseous artery flap design. The mark X indicates the position of the cutaneous perforators confirmed with color Doppler examination. (D) Appearance of flap harvest. (E) Intraoperative palmar view. (F) Intraoperative lateral view. (G) A vascular anastomotic site (an enlargemant of the area enclosed by dots in [F]). (H) Palmar view 7 months after surgery. (I) Lateral view 7 months after surgery.

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  Fig. 2. (A) Preoperative palmar view. (B) Preoperative lateral view. (C) Palmar view 17 months after surgery. (D) Lateral view 17 months after surgery.

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  Fig. 3. Types of venous anastomoses. Left panels: before vascular anastomosis, right panels: after vascular anastomosis. (A) Type 1: two concomitant veins of PIA were anastomosed to two concomitant veins of radial artery. (B) Type 2: one concomitant vein of PIA was anastomosed to one concomitant vein of radial artery and the other concomitant vein of PIA was done to a tributary of the cephalic vein. (C) Type 3: junction of concomitant veins accompanying PIA was anastomosed to one concomitant vein of radial artery. (D) Type 4: junction of concomitant veins accompanying PIA was anastomosed to a tributary of the cephalic vein. PIA: posterior interosseous artery, RA: radial artery, SubcV: subcutaneous vein. *Flap.

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