Arch Hand Microsurg 2019; 24(4): 408-415  
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
Departments of 1Plastic and Reconstructive Surgery and 2Dermatology, Hamamatsu University School of Medicine, Hamamatsu, Japan
Correspondence to: 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: July 1, 2019; Revised: July 30, 2019; Accepted: August 23, 2019; Published online: December 1, 2019.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

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


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