The interosseous flap for coverage of soft tissue defects at the hand

Summary

Objectives

Coverage of a soft tissue defect at the hand with a pedicled fasciocutaneous flap.

Indications

Primary or secondary skin and soft tissue defects at the hand of less than 15×5 cm.

Contraindications

Absent posterior interosseous artery.

Absent anastomosis between posterior and anterior interosseous arteries.

Defects smaller than 3×3 cm; they should be closed through mobilization of the surrounding tissues.

Surgical Technique

Marking of flap.

The first skin incision is done at the ulnar side of the marked flap and deepened to the fascia of the extensor carpi ulnaris muscle. Dissection of the intermuscular septum while preserving the perforating skin vessels of posterior interosseous artery. Incision at the radial side and dissection of the intermuscular septum from radial without injuring the motor branches of the radial nerve. Ligation of the posterior interosseous artery distal to the motor branches. Detachment of the pedicle through coagulation of the branches going to muscles and bone. Detachment of the intermuscular septum from ulnar. Exposure of the communication with the anterior interosseous vessels.

Spreading and tensionless suturing of flap into the defect. Avoid kinking of defect. Primary closure of the site of harvesting or coverage with full or split thickness skin graft.

Results

During a period of 3.5 years this technique was used in 10 patients. The average time to healing: 15.9 days. Average duration of follow-up: 19.1 months. All flaps were incorporated. The only complication was a venous congestion in the flap in 2 patients.