Osteocutaneous Posterior Interosseous Flap for Reconstruction of the Metacarpal Bone and Soft-Tissue Defects in the Hand

Abstract

A vascularized bone segment of the ulna together with a posterior interosseous fasciocutaneous flap is harvested, including a cuff of the extensor pollicis longus muscle. The authors treated five male patients with metacarpal bone and soft-tissue defects of the hand using a distally based island osteocutaneous posterior interosseous flap. Their ages at the time of surgery ranged from 15 to 37 years (mean, 24 years). The bone defects were in the first metacarpal in three cases, the fourth metacarpal in one, and the fifth metacarpal in one. The length of the donated ulna ranged from 3 to 7 cm (mean, 5 cm). The follow-up period ranged from 5 to 92 months (mean, 39 months). All flaps survived completely. The posterior interosseous flap provides thin skin of good texture, together with vascularized bone, for a one-stage reconstruction of the metacarpal bone and soft-tissue defects in the hand.

Vascularized Medial Femoral Condyle Graft for Thumb Metacarpal Reconstruction: Case Report

“…9 Pedicled bone grafts from the radius based on the radial artery or posterior interosseous artery have been used to reconstruct segmental metacarpal defects. 23,24 Although these flaps have the advantage of not requiring microsurgical anastomoses, they are associated with substantial potential donor site morbidity, including pathologic fracture and sacrifice of the radial artery. Many free vascularized bone grafts have also been used for metacarpal reconstruction, including the fibula, iliac crest, scapula, metatarsal, and rib.…”

Vascularized Bone Blocks From the Toe Phalanx to Solve Complex Intercalated Defects in the Fingers

“…[1][2][3][4][5]16,17 When the defect to be reconstructed is located in a finger and there is the need for a vascularized bone graft for any reason, the problem is that there are virtually no donor sites. Cortical segments from long bones-namely the radius, 21 humerus, 22 ulna, 23,24 and metatarsals 25,26 -have been transferred successfully to the hand. With some exceptions most of the literature is composed of case reports.…”

Thinned chimeric radial collateral artery perforator flap in complex distal thumb reconstruction

“…These procedures should be conducted in a combined operation instead. Complex defects are ideally repaired in one-stage reconstructive procedures by using single multi-component vascularized flaps, including osteocutaneous radial forearm and osteocutaneous posterior interosseous artery flap [1,17,39,42,43].…”

“…Such flaps include fibula osteocutaneous flaps [29,41], iliac osteocutaneous flaps [34], osteocutaneous flap from the medial femoral condyle [19,33], osteocutaneous radial forearm [20], osteocutaneous posterior interosseous artery flap [1], and vascularized ribs with serratus anterior and latissimus dorsi [23]. However, these flaps may be unnecessary in small defects such as those less than 15 cm 2 .…”