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

Affiliations
  • 1Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. masaofuj@mth.biglobe.ne.jp
  • 2Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan.

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

  • 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.

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

  • 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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