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KMID : 1143020190240040408
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Archives of Hand and Microsurgery
2019 Volume.24 No. 4 p.408 ~ p.415
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Free Posterior Interosseous Artery Flap for Treatment of First Web Space Contracture: Methods of Venous Anastomosis
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Fujiwara Masao
Matsushita Yuki
Maeba Yoshikane
Suzuki Ayano
Fukamizu Hidekazu
Tokura Yoshiki
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Abstract
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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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KEYWORD
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Free posterior interosseous artery flap, First web space contracture, Venous anastomosis
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