An extended distally based reverse posterior interosseous artery flap reconstruction for the thumb and distal defects of the fingers. Issue 5 (20th April 2021)

• Record Type: Journal Article
• Authors: Kocman, Emre A.; Kavak, Mustafa; Kaderi, Sina; Karabagli, Yakup
• Is Part Of: Microsurgery. Volume 41:Issue 5(2021)
• Page Start: 430
• Page End: 437
• Publication Date: 2021-04-20
• Subjects: Microsurgery -- Periodicals; 617.05
• DOI: 10.1002/micr.30746
• Languages: English
• ISSNs: 0738-1085

Abstract

Abstract: Background: The reverse posterior interosseous artery flap is useful for covering hand defects. However, its major drawback is the short pedicle that limits the reach of the flap up to the metacarpophalangeal level. The authors performed a new modification extending the distal reach of the flap by including the recurrent branch of the posterior interosseous artery and they aimed to present the results of reconstruction with this technique. Patients and methods: Seven patients with a mean age of 35.2 years (range 17–64 years) underwent extended RPIAF surgery. Six patients were admitted to the emergency department with isolated hand trauma. One patient was present in elective settings with chronic osteomyelitis and skin loss of the thumb related to previous trauma. The defects were located on the distal metacarpophalangeal level (thumb and other fingers). PIA perforators and the recurrent branch were included into the pedicle (Type A) in five cases, whereas the flap was harvested based solely on the recurrent branch (Type B) in two cases. The type B flaps had longer pedicle lengths due to discarding the forearm skin. The donor sites were covered with skin grafts in six patients. Results: The average size of the extended RPIAF was 3 × 3.5 cm to 10 × 6 cm (mean 8.28 × 4.14 cm). All of the flaps completely survived, and no complications were encountered during the postoperative period. Functional recovery of the operated hands were observed during the follow up period 13.5 months (8–24 months). Both the patient and our satisfactory levels were high and all of the patients returned to their works. Quick DASH score was used in the final functional evaluation retrospectively. Due to the pandemic, the evaluation could be made with a telephone. Two patients could not be reached in the evaluation. The mean quick DASH score of five patients was 28.64. Conclusion: The extended RPIAF is a reliable choice in distally located thumb and finger defects if the recurrent branch of the posterior interosseous artery is included in the pedicle.