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Reversed posterior interosseous flap: safe and easy method for hand reconstruction.

ABSTRACT:

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Complex hand trauma presents multifaceted problems for the surgeon. Soft tissue defects of the upper extremity must be carefully assessed to determine the most appropriate method of coverage of hand. In this article, the reversed posterior interosseous flap was used for coverage of the hand. The injured areas include: dorsum of the hand (10 cases), the wrist (3 cases) and the dorsal thumb (2 cases). All flaps survived completely and none exhibited venous compromise. All donor sites were skin grafted. The reversed posterior interosseous flap is a versatile option for coverage of moderate sized defects of the hand and is specifically indicated for coverage of injuries of the wrist, dorsal hand and dorsal thumb.

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The online version of this article (doi:10.1007/s12593-011-0042-y) contains supplementary material, which is available to authorized users.

SUBMITTER: El-Sabbagh AH

PROVIDER: S-EPMC3172356 | biostudies-literature | 2011 Dec

REPOSITORIES: biostudies-literature

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Reversed posterior interosseous flap: safe and easy method for hand reconstruction.

El-Sabbagh Ahmed Hassan AH Zeina Ahmed Abd El-Moaty AA El-Hadidy Al-Moddather AM El-Din Ahmed Bahaa AB

Journal of hand and microsurgery 20110506 2

<h4>Unlabelled</h4>Complex hand trauma presents multifaceted problems for the surgeon. Soft tissue defects of the upper extremity must be carefully assessed to determine the most appropriate method of coverage of hand. In this article, the reversed posterior interosseous flap was used for coverage of the hand. The injured areas include: dorsum of the hand (10 cases), the wrist (3 cases) and the dorsal thumb (2 cases). All flaps survived completely and none exhibited venous compromise. All donor ...[more]

PMID: 23204772

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Project description:BackgroundThe predominant method for Manske type IIIB and IV thumb hypoplasia is pollicization. However, for those who are not willing to sacrifice the index finger, a method that could reconstruct a functionally capable and aesthetically acceptable thumb remains desirable. This study aimed to investigate and assess the functional and radiographic outcomes of utilizing a reversed vascularized second metatarsal composite flap for thumb reconstruction as a new alternative.MethodsFrom May 2014 to January 2017, 15 patients with Manske type IIIB or IV thumb hypoplasia who were admitted to the Department of Hand Surgery, Beijing Jishuitan Hospital were included in this study. An osteocutaneous flap containing a section of second metatarsal and its distal head was transferred in reversed position to reconstruct carpometacarpal joint. The donor site was reconstructed by a split half of the third metatarsal. Various functional reconstructions were commenced at second stage. The reconstructed thumbs were evaluated using the Kapandji score, pinch force, and the capacities of performing daily activities through a detailed questionnaire.ResultsAmong these 15 patients (seven type IIIB and eight type IV), there were ten boys and five girls with median age of 4.2 years (range: 2.0-7.0 years). There were seven right, three left, and five bilateral thumbs for whom only the right thumb received surgery. There were 14 metatarsal flaps survived (14/15). With an average follow-up of 19.2 months, the reconstructed thumbs had acceptable functional and aesthetic outcomes and the donor foot presented in decent appearance without signs of impaired function. All 15 children have improved the Kapandji score (from 0 to an average of 6.7), pinch force (from 0 to an average of 1.5 kg), with ability of grip and pen holding. X-ray indicated continuous bone growth. Patients and parents had good acceptance of the new thumb.ConclusionsReconstruction of an unstable hypoplastic thumb (Manske type IIIB and IV) with use of a vascularized metatarsal is an effective strategy. It offers an alternative solution for parents insisting on saving the thumb.

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Reversed posterior interosseous flap: safe and easy method for hand reconstruction.

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Electronic supplementary material

Publications

Reversed posterior interosseous flap: safe and easy method for hand reconstruction.

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