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

Fujiwara,  Masao; Matsushita,  Yuki; Maeba,  Yoshikane; Suzuki,  Ayano; Fukamizu,  Hidekazu; Tokura,  Yoshiki

doi:2019.24.4.408

Arch Hand Microsurg > Volume 24(4); 2019 > Article

Original Article

Archives of Hand and Microsurgery 2019;24(4):408-415.
Published online December 1, 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, Yoshiki Tokura²

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.

Received: 1 July 2019 • Revised: 30 July 2019 • Accepted: 23 August 2019

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.

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