Khan Fahad Hanif, Rahman Obaid Ur, Beg Mirza Shehab Afzal
Department of Plastics and Reconstructive Surgery, Liaquat National Hospital, Karachi, Pakistan.
Department of Plastics and Reconstructive Surgery, Liaquat National Hospital, National stadium road, Karachi, Pakistan.
JPRAS Open. 2022 Feb 9;32:48-53. doi: 10.1016/j.jpra.2022.01.007. eCollection 2022 Jun.
Full-thickness defects on the dorsum of the hand requires thin, soft, and pliable skin for which there are limited locoregional flaps. The reverse posterior interosseous artery (PIA) flap based on the communicating artery fulfills all above requirements and can reach upto the fingers. However, there has been discrepancy in the surface marking of the flap and the anatomical position of the vessel pedicle. We share our alteration with the marking and ease of harvesting this flap.
This is a prospective study conducted at a private teaching hospital in Karachi, over a period of 2 years from November 2017 to December 2019. After taking consent and ensuring confidentiality of all patients who had PIA flap reconstruction, we collected patient's demographic details, mode of injury, and flap surface area. We altered the described skin marking and took measures to prevent venous congestion and noted the outcomes in term of flap congestion and flap loss.
Twenty-eight patients with a mode age of 32 years were operated during this period. The majority (64.2%) had a motor vehicle accident and machine injuries. The mean surface area of flaps was 6 × 10 cm, and 11 (39.2%) flaps had venous supercharging. All patients had a 10-20° wrist extension splint for 2 weeks. The mean follow-up of the patients was 14 ± 5 days, and 6 (21.4%) flaps developed a minimal marginal flap loss, which was managed conservatively.
By minimally altering our surface marking, we experienced a easy and quick harvesting of this flap. However, one has to be vigilant and take all described precautions for venous congestion.
手背全层缺损需要薄、软且柔韧的皮肤，但局部皮瓣供应有限。基于交通动脉的逆行骨间后动脉（PIA）皮瓣满足上述所有要求，且可延伸至手指。然而，该皮瓣的体表标记与血管蒂的解剖位置存在差异。我们分享了我们对该皮瓣标记的改进以及获取该皮瓣的简便方法。
这是一项在卡拉奇一家私立教学医院进行的前瞻性研究，时间跨度为2017年11月至2019年12月的2年。在征得所有接受PIA皮瓣重建患者的同意并确保其隐私后，我们收集了患者的人口统计学细节、受伤方式和皮瓣表面积。我们改变了所描述的皮肤标记，并采取措施预防静脉淤血，记录皮瓣淤血和皮瓣坏死方面的结果。
在此期间，28例患者接受了手术，平均年龄为32岁。大多数患者（64.2%）因机动车事故和机器损伤导致受伤。皮瓣的平均表面积为6×10平方厘米，11例（39.2%）皮瓣进行了静脉增压。所有患者均佩戴10 - 20°腕背伸夹板2周。患者的平均随访时间为14±5天，6例（21.4%）皮瓣出现轻微边缘性皮瓣坏死，经保守治疗处理。
通过对体表标记进行最小程度的改变，我们能够轻松快速地获取该皮瓣。然而，必须保持警惕并采取所有所述的预防静脉淤血的措施。
