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