Thumb reconstruction by the anterior interosseous osteocutaneous retrograde island flap

Summary An original method for thumb reconstruction by the anterior interosseous osteocutaneous island flap is presented. This flap, based on the superior perforating branch of the anterior interosseous artery, is located on the posterior aspect of the forearm, over the distal third of the radius. The dorsal vascular network of the wrist allows the flap to be raised as a retrograde island flap to reach all the parts of the first ray for reconstruction of osteocutaneous loss of the thumb. Two cases have been operated upon successfully with a satisfactory result.     

Proximally pedicled musculocutaneous anterior interosseous flap for cubital fossa reconstruction

Based on preexisting anatomic studies and our experience related to the upper extremity flaps, a proximally pedicled anterior interosseous flap was developed and used in 1 patient for the reconstruction of skin defect of cubital fossa and the biceps brachii muscle. The distal half of the brachioradialis muscle was included in the flap. The recovery of the elbow was excellent, with a full range of movement. The important conclusion from this case is that the superior perforating branch of the anterior interosseous artery may be used as the basis of an alternative regional flap for the cubital fossa.     

The anterior interosseous nerve syndrome.

A follow-up examination of 21 cases of anterior interosseous nerve syndrome in 20 patients is presented. In 15 patients the anterior interosseous nerve was explored, with objective signs of compression in nine. 11 of these patients showed satisfactory function and three had a tendon transfer. Five cases were not operated on. Two recovered and three had continuous paralysis after more than four years. One patient had a primary tendon transfer. We conclude that exploration of the anterior interosseous nerve is the treatment of choice, and that expectant treatment can be reserved for patients with slight disability or poor general health. As recovery may take over a year, tendon transfer should be postponed until after this period in patients who do not show satisfactory recovery.     

以骨间前动脉背侧支为蒂桡骨皮瓣的临床应用

目的为临床提供一种新的骨皮瓣移位术式。方法１０侧成人上肢标本经肱动脉灌注乳胶后，对其骨间前动脉背侧支的起始部位、口径、长度及其皮支、骨膜支的分布进行显微解剖观察。临床设计以骨间前动脉背侧支为蒂的桡骨皮瓣逆行移位，骨皮瓣中桡骨瓣支撑于第一、二掌骨间或修复掌骨缺损，皮瓣修复虎口、手背尺桡侧的皮肤缺损。结果临床应用６例，皮瓣全部成活。术后随访４～１２个月，受区移植骨已骨性愈合。结论骨间前动脉背侧支为蒂的逆行桡骨皮瓣，适用于修复掌部软组织合并掌骨缺损及重度虎口挛缩的病例。     

Posterior interosseous reverse flap

Losses of skin substance of the dorsal face of the hand occasionally justify resorting to cover flaps when the noble elements (bones, tendons) are whether damaged or exposed. Few flaps allow filling in these losses of substance. Among those, which do, posterior interosseous reverse flap is indicated in some cases. We will present the technique and the main indications for the posterior interosseous flap. It is an island flap receiving reverse-flow vascularisation by the posterior interosseous artery. This flap is harvested from the second proximal quarter of a line extending from the lateral epicondyle of humerus to the ulnar head. The antebrachial fascia is incised longitudinally on the ulnar extensor of wrist and digiti minimi. The cutaneous flap is raised from radial to ulnar while sectioning the different intermuscular septa. Only the septum dividing the digiti minimi and ulnar extensor of wrist is preserved because it contains the pedicle. Once the main pedicle is identified, the skin paddle can be raised from proximal to distal. Then the septum holding the pedicle is detached from the ulna through to the distal radio-ulnar articulation, level with the bone surface. This flap is appropriate for losses of skin substance of the dorsal face of the hand extending to the first phalanxes and the first commissure. It can also be used to cover the anterior face of the wrist and is perfectly suited for retraction of the first commissure. Contrarily to the Chinese and ulnar flaps, it does not cause any damage to any significant arterial axis. Its main drawback is the scar on the donor site, which is often unsightly, while in the child; direct closure is possible in most cases.     

Retrograde posterior interosseous flap

A retrospective, continuous clinical series of 36 distally based posterior interosseous island flap procedures is reported. Major anatomic variations precluded the final dissection of the flap on two occasions (6%). Thirty-four patients had septocutaneous or septofascial flap coverage for treatment of acute complex injuries (12), subacute soft tissue defects (10), chronic ulcers (5), or contractures (7). The sizes of the flap islands varied from 1.5 by 4 centimeters to 9 by 11 centimeters. The arc of rotation, centered over the distal radioulnar joint, measured up to 19 centimeters, allowing the flaps to reach the dorsum of the proximal interphalangeal joints. Partial necrosis occurred in seven flaps; four (12%) required additional local or distant flaps. Partial failures were related to bleeding from the pedicle or compression thereof, while other assumed causes of hypoperfusion were not statistically relevant. The flaps remained slightly bulky in about 30% of the patients, but otherwise adapted well to the recipient site and had excellent texture and color match. The donor morbidity was minimal.     

骨间前动脉桡侧骨皮支皮瓣的临床应用

目的：研究应用骨间前动脉桡侧骨皮支皮瓣的方法和疗效。方法：利用骨间前动脉桡侧骨皮支与肌皮支恒定吻合,供养前臂背侧较大区域皮肤的解剖学基础,形成前臂背侧桡侧皮瓣,修复虎口部皮肤缺损4例。结果：皮瓣全部成活,术后随访外形功能良好。结论：骨间前动脉桡侧皮支皮瓣具有切取简便,血供可靠,创伤小的特点,是临床较为理想的选择。     

Posterior interosseous island forearm flap

The skin of the dorsal aspect of the forearm is supplied by several cutaneous branches of the posterior interosseous artery. This vascular anatomy permits the surgeon to obtain an island flap of the dorsal forearm based on the distal anastomosis between the two interosseous arteries at the distal part of the interosseous space. This flap can reliably be transferred to different skin defects of the hand such as those created by correction of an adduction contracture of the first web space, or on the back or front of the wrist level. Its principal advantages are that it is a thin flap with excellent circulation and that it is possible to close the donor area primarily provided the island flap is not wider than 3 to 4 cm. The procedure has been employed in 25 patients with satisfactory results.     

以骨间前动脉及背侧支为蒂组织瓣的临床应用

目的报道以骨间前动脉及背侧支为蒂组织瓣移位术的手术方法。方法临床设计以骨间前动脉及背侧支为蒂的组织瓣共20例；其中逆行岛状皮瓣4例，逆行岛状骨瓣4例，顺行岛状骨瓣2例，逆行岛状骨膜瓣2例，逆行岛状骨皮瓣8例。应用组织瓣修复手背、虎口皮肤缺损，修复掌骨缺损、尺骨骨不连、月骨无菌性坏死等。结果11例皮瓣和骨皮瓣全部成活，1例皮瓣远端部分坏死，经植皮后愈合。术后随访3个月～4年，受区移植骨全部骨性愈合，手部功能满意。结论以骨间前动脉及背侧支为蒂的组织瓣可设计成多种类型，是修复手及前臂复合组织缺损的良好供区。     

The anterior interosseous nerve syndrome

Summary Four cases of the anterior interosseous nerve syndrome, which were treated by neurolysis, are added to the sixty-five already described in the literature. The onset of symptoms is usually spontaneous and electrophysiological examination is of value in making the diagnosis. The most frequent cause of the entrapment is fibrous bands in the pronator teres muscle. The outcome after operation is better for complete lesions than for partial lesions which involve the thumb or index finger only.

---

Résumé L'auteur ajoute quatre cas de syndrome du nerf inter-osseux antérieur, qu'il a traités par neurolyse, aux 65 cas déjà décrits dans la littérature. Les symptômes surviennent habituellement de façon spontanée et les examens électriques sont utiles au diagnostic. La cause la plus fréquente de la compression est un tractus fibreux situé dans le rond pronateur. L'évolution post-opératoire est meilleure dans les atteintes totales que dans les partielles, ne concernant seulement que le pouce ou l'index.

     

Reversed forearm island flap with dorsal interosseous artery for reconstruction of postburn deformities of the hand--report of 6 cases

This paper presents six cases with severe postburn hand deformity repaired with the reverse forearm flap based on distal portion of posterior interosseous artery. All 6 flaps attained 100% survival rate. Regional anatomy of the flap is briefly reviewed. Design and dissection of the flap are described in detail. Advantages of this flap and some operative key points are discussed.     

The posterior interosseous artery flap revisited

There are many ways to replace soft tissues that cover of the hand, from the simplest, eg, split-thickness skin graft to complex, eg, a microvascular free tissue transfer. The multiple, parallel sources of blood supply to the hand, and their arch-like interconnections offer a wide possibility of local reverse-flow or retrograde flaps. The most commonly used, eg, the radial arm flap, typically results in the sacrifice of a major artery. Though somewhat more technically demanding, the posterior interosseous artery flap can be used to cover a wide range of defects of the hand and wrist without potentially compromising circulation to the hand. The anatomy, potential applications and the surgical techniques important to success are discussed.     

The anterior interosseous flap in wrist and hand surgery: a series of fifteen cases

INTRODUCTION: Fifteen anterior interosseous flaps were used to reconstruct wrist and hand defects in fifteen patients (thirteen men and two women) with a mean of 38 years (27-42 years). PATIENTS AND METHODS: Seven anterior interosseous osteoperiosteal flaps and eight anterior interosseous osteocutaneous flaps were used. Seven island flaps and eight free flaps based on the anterior interosseous artery were raised. The indications were scaphoid non-union (4 cases), first metacarpal non-union (2 cases), proximal phalanx non-union (1 case), Kienb?ck's disease (2 cases), osteocutaneous phalangeal defects (3 cases), osseous capitatum defect (1 case) and intracarpal arthrodesis (2 cases). RESULTS: Postoperatively, one fracture of the distal end of the radius was noted because of a large osteoperiosteal corticotomy. Osseous reconstruction was usually consolidated at three months. One failure was noticed (Kienb?ck's disease). No significant deformity was noticed in the donor site. CONCLUSION: The anterior interosseous flap seems to be a useful alternative to reconstruct small or moderate defects in wrist and hand surgery.     

改良型骨间背侧动脉岛状皮瓣

目的 介绍一种改良的骨间背侧动脉岛状皮瓣新术式。方法 在骨间背血管暴露段的一条皮支远端设计皮瓣，将皮瓣在该皮支的远端段与骨间背血管主干分离，使原本需在前臂近端设计的皮瓣转向前臂远端设计，从而减小手术切口及防止损伤骨间背神经。结果 9例皮瓣均成活，皮瓣质地良好。结论 该改良型骨间背皮瓣较传统骨间背皮瓣具有减轻手术创伤，减少骨间背神经损伤可能性的优点。