Gong Xu, Lu Lai-Jin
Department of Hand Surgery, The First Hospital of Ji Lin University, Chang Chun, China.
J Trauma. 2011 Dec;71(6):1745-9. doi: 10.1097/TA.0b013e3182325e27.
To evaluate the outcome and highlight the operative tips of using the reverse posterior interosseous artery (PIA) flap in the treatment of severe contractures of the first web space.
From 1985 to 2008, the reverse PIA flaps, which included fasciocutaneous flaps in 25 patients and composite flaps in 2 patients were used to cover skin defects over the first web space after release of severe contractures of the first web space. The severe contracture of the first web space was defined as the distance of less than 2 cm between the interphalangeal joint of the thumb and the metacarpophalangeal joint of the index. The flap dimensions varied between 6 cm and 22 cm (average, 13 cm) in length and 3 cm to 9 cm (average, 6 cm) in width. The largest flap was 22 cm × 6 cm and the smallest 6 cm × 3 cm. The length of the pedicle ranged from 2 cm to 10 cm (average, 8 cm). Skin defects of the donor site were covered by split-thickness skin grafts in 26 patients and direct closure in 1 patient.
Twenty-six of 27 PIA flaps survived completely except venous congestion occurred in 1 patient, which led to necrosis of the distal 1/4 flap. Skin grafts over the donor sites survived completely without complications. The follow-up period ranged from 1 month to 2 years. Lipectomy or revision was performed in two patients because of scar contractures or bulkiness. The postoperative distance of the reconstructed web space was 6 cm on average.
The reverse PIA flap is suited for defect cover in the treatment of severe contractures of the first web space. A usual pitfall using the reverse PIA flap is that the skin paddle is inadvertently outlined over the proximal 1 of 3 forearm to increase its distal reach, which usually leads to postoperative venous congestion. However, if the distal flap pole is placed at or distal to the midpoint from the lateral epicondyle to the radial side of the ulnar head, choosing the proximal 1 of 2 forearm as the donor site of the skin paddle to increase its distal reach is reliable.
评估采用逆行骨间后动脉（PIA）皮瓣治疗第一掌骨间隙严重挛缩的疗效，并强调手术技巧。
1985年至2008年，采用逆行PIA皮瓣（其中25例为筋膜皮瓣，2例为复合皮瓣）覆盖第一掌骨间隙严重挛缩松解术后的皮肤缺损。第一掌骨间隙严重挛缩定义为拇指指间关节与示指掌指关节之间距离小于2cm。皮瓣长度在6cm至22cm之间（平均13cm），宽度在3cm至9cm之间（平均6cm）。最大皮瓣为22cm×6cm，最小为6cm×3cm。蒂长在2cm至10cm之间（平均8cm）。26例供区皮肤缺损采用中厚皮片移植覆盖，1例直接缝合。
27例PIA皮瓣中26例完全存活，1例出现静脉淤血，导致皮瓣远端1/4坏死。供区皮片完全存活，无并发症。随访时间为1个月至2年。2例因瘢痕挛缩或臃肿行脂肪切除术或修复术。重建掌骨间隙术后平均距离为6cm。
逆行PIA皮瓣适用于治疗第一掌骨间隙严重挛缩的缺损覆盖。使用逆行PIA皮瓣常见的失误是在距前臂近端1/3处无意中勾勒皮瓣，以增加其远端长度，这通常会导致术后静脉淤血。然而，如果皮瓣远端置于从肱骨外上髁至尺骨头桡侧中点或更远端，选择前臂近端1/2作为皮瓣供区以增加其远端长度是可靠的。
