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

Masao Fujiwara; Yuki Matsushita; Yoshikane Maeba; Ayano Suzuki; Hidekazu Fukamizu

doi:10.12790/ahm.2019.24.4.408

Journal List > Arch Hand Microsurg > v.24(4) > 1143619

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Fujiwara, Matsushita, Maeba, Suzuki, and Fukamizu: Free Posterior Interosseous Artery Flap for Treatment of First Web Space Contracture: Methods of Venous Anastomosis

Original Article

Arch Hand Microsurg 2019;24(4):408-415.

Published online: 5 January 2019

DOI: https://doi.org/10.12790/ahm.2019.24.4.408

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

Masao Fujiwara¹, Yuki Matsushita¹, Yoshikane Maeba¹, Ayano Suzuki¹, Hidekazu Fukamizu¹

¹Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan

²Department of Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan

Corresponding author: Masao Fujiwara Department of Plastic and Reconstructive Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, Shizuoka 431-3192, Japan TEL: +81-534352798, FAX: +81-534352798, E-mail: masaofuj@mth.biglobe.ne.jp, ORCID: https://orcid.org/0000-0003-0520-6799

Received 1 July 201930 July 2019 Accepted 23 August 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

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.

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Keywords: Free posterior interosseous artery flap, First web space contracture, Venous anastomosis

REFERENCES

1.Tonkin MA., Stern H. The posterior interosseous artery free flap. J Hand Surg Br. 1989. 14:215–7.

2.Chen HC., Tang YB., Chuang D., Wei FC., Noordhoff MS. Microvascular free posterior interosseous flap and a comparison with the pedicled posterior interosseous flap. Ann Plast Surg. 1996. 36:542–50.

3.Park JJ., Kim JS., Chung JI. Posterior interosseous free flap: various types. Plast Reconstr Surg. 1997. 100:1186–97. discussion 1198-9.

4.Shibata M., Iwabuchi Y., Kubota S., Matsuzaki H. Compari-son of free and reversed pedicled posterior interosseous cutaneous flaps. Plast Reconstr Surg. 1997. 99:791–802.

5.Cavadas PC. Posterior interosseous free flap with extend-ed pedicle for hand reconstruction. Plast Reconstr Surg. 2001. 108:897–901.

6.Eo SR., Hwang SH., Hong KY., Lim SA., Lee GJ. Revisiting the posterior interosseous artery flap. Arch Hand Microsurg. 2018. 23:195–205.

7.Angrigiani C., Grilli D., Dominikow D., Zancolli EA. Posterior interosseous reverse forearm flap: experience with 80 consecutive cases. Plast Reconstr Surg. 1993. 92:285–93.

8.Fujiwara M., Kawakatsu M., Yoshida Y., Sumiya A. Modified posterior interosseous flap in hand reconstruction. Tech Hand Up Extrem Surg. 2003. 7:102–9.

9.Chen HC., Cheng MH., Schneeberger AG., Cheng TJ., Wei FC., Tang YB. Posterior interosseous flap and its variations for coverage of hand wounds. J Trauma. 1998. 45:570–4.

10.Costa H., Soutar DS. The distally based island posterior interosseous flap. Br J Plast Surg. 1988. 41:221–7.

11.Costa H., Pinto A., Zenha H. The posterior interosseous flap - a prime technique in hand reconstruction. The experience of 100 anatomical dissections and 102 clinical cases. J Plast Reconstr Aesthet Surg. 2007. 60:740–7.

12.Pan ZH., Jiang PP., Wang JL. Posterior interosseous free flap for finger re-surfacing. J Plast Reconstr Aesthet Surg. 2010. 63:832–7.

13.Tahara S., Takagi T., Kinishi M., Makino K., Amatsu M. Role of the perforating vein in vascular pedicle of free forearm flap. Microsurgery. 1995. 16:743–5.

14.Liu J., Song D., Xu J., Li J., Li K., Lv H. Use of free modi-fied innervated posterior interosseous artery perforator flap to repair digital skin and soft tissue defects. Indian J Surg. 2015. 77(Suppl 3):886–92.

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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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Table 1.

Clinical profile of the patients

Case No.	Age (yr)	Sex	Lesion site	Cause	Flap size width×length (mm)	Number of anastomoses between pCV and rCV	Number of anastomoses between pCV and subV	Classification of venous anastomosis	n Result	Follow-up period (mo)	Preoperative thumb abduction		Postoperative thumb abduction
Case No.	Age (yr)	Sex	Lesion site	Cause	Flap size width×length (mm)	Number of anastomoses between pCV and rCV	Number of anastomoses between pCV and subV	Classification of venous anastomosis	n Result	Follow-up period (mo)	Radial abduction (°)	Palmar abduction (°)	Radial abduction (°)	Palmar abduction (°)
1	47	M	R	Incomplete hand amputation	35×150	2	0	Type 1	CS	7	34	60	75	80
2	56	M	L	Degloving injury	35×150	1 (junction)	0	Type 3	CS	17	32	46	90	88
3	40	M	L	Press injury, open fracture	35×155	1	1	Type 2	CS	4	40	39	70	82
4	59	M	L	Burn	40×150	0	1 (junction)	Type 4	CF	-	-	-	-	-
5	35	M	R	Crush	40×160	2	0	Type 1	CS	10	28	39	55	76
6	45	M	R	Crush	35×160	2	0	Type 1	CS	9	30	35	56	70
7	60	M	R	Press injury	30×155	1	1	Type 2	CS	6	26	35	62	68

Type 1: two concomitant veins of PIA were anastomosed to two concomitant veins of radial artery. 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. Type 3: junction of concomitant veins accompanying PIA was anastomosed to one concomitant vein of radial artery. Type 4: junction of concomitant veins accompanying PIA was anastomosed to a tributary of the cephalic vein. PIA: posterior interosseous artery, pCV: concomitant vein of posterior interosseous artery, rCV: concomitant vein of radial artery, subV: subcutaneous vein, M:male, R:right, L: left, CS: complete survival, CF: complete flap failure, -: not available.

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