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.

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

REFERENCES

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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.

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.

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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