Thumb reconstruction by the anterior interosseous osteocutaneous retrograde island flap

Abstract

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.The choice of technique in thumb reconstruction represents a delicate balance between potential gains of the envisaged procedure and the price paid at any given donor site. A simple and economical one-stage thumb reconstruction technique is described. The anterior interosseous island flap is used, this is based on the superior perforating branch of the anterior interosseous artery. AnatomyThe anterior interosseous retrograde island flap has been previously described in 1991 [5][6][7]. This anatomical study was performed on 44 upper limbs of fresh cadavers with various injection materials. The findings are summarized as follows:1. The anterior interosseous artery originates from the common interosseous artery which branches from the ulnar artery in 95.5% of cases. It arises between the insertions of the flexor pollicis longus and the flexor Correspondence to. Dr. W. Hu, Department of Plastic and Reconstructive Surgery, Surgery of the Hand and Microsurgery, PellegrinTondu Hospital, Place Am6lie-Raba-L~on, F-33076 Bordeaux Cedex, France digitorum profundus muscles and has an average caliber of 1.5 mm at its origin. The vessel lies close to the interosseous membrane of the forearm accompanied by the anterior interosseous nerve, and it gives off 3-4 small branches to the supinator and 5-7 to the flexor pollicis longus and the flexor digitorum profundus. Most of these muscle branches are located in the proximal half of the forearm.In the distal half of the forearm, the anterior interosseous artery gives several perforating branches (on average 6) which perforate the interosseous membrane to supply the dorsal aspect of the distal two-third of the forearm. The two principal ones are named "the superior and the inferior perforating branches". At the level of the pronator quadratus the anterior interosseous artery divides into two terminal branches: the inferior perforating branch and the anterior terminal branch (Fig. 1). The latter supplies the pronator quadratus and in 73% of cases it joins the volar vascular network of the wrist which is dominated by the radial and the ulnar arteries.2. The superior perforating branch of the anterior interosseous artery perforates the interosseous membrane 10+2 cm above the radio-carpal joint line and runs in the septum between the extensor pollicis longus and brevis muscles accompanied by two venae comitantes. The calibre of the artery at its origin varies from 0.9 to 1.5 mm. During its course, the artery gives off 5-7 cutaneous branche...

Reconstruction of maxillary and palatal defects with the free radial forearm flap

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Le lambeau interosseux antérieur dans la chirurgie du poignet et de la main : à propos de 15 cas

“…Le lambeau interosseux anté-rieur peut en théorie atteindre l'extrémité distale des doigts car le centre de rotation peut être repoussé très loin en distal jusqu'au niveau de la tête du capitatum [22]. En 1994, Hu et al [23,24] utilisent les artères postérosupérieure et postéro-inférieure de l'artère interosseuse antérieure pour permettre un important arc de rotation du lambeau interosseux anté-rieur ostéocutané pédiculé permettant la reconstruction osté-ocutanée de pouces et de doigts longs. Au niveau du poignet, Akin [25] propose l'utilisation d'un lambeau en îlot d'avancement en V-Y fondé sur l'artère interosseuse antérieure pour la reconstruction de défects dorsaux du poignet chez deux Fig.…”

Surgical Approaches from an Angiosomal Perspective

“…These septocutaneous branches have been used as the vascular base of a reverse flap that is able to incorporate skin, dorsal distal radius, and distal posterior interosseous nerve as a composite flap. 12,13 The 2,3 SRA arises variably from the common AIA or dorsal branches of the AIA. It courses over the extensor retinaculum and Lister' s tubercle, sending deep perforating branches that usually penetrate into cancellous bone.…”