Posterior interosseous free flap for finger re-surfacing

The authors present their clinical experience and surgical methods of soft-tissue coverage for the finger using a posterior interosseous free flap.

Twelve posterior interosseous free flaps, including two dual-paddle flaps, were performed in 12 patients. Indications included: 1) patients with soft-tissue coverage of the dorsum of the finger (n=4), pulp (n=1), fingertip and pulp (n=5), 2) patients subsequent to release of finger and palm contracture (n=1) and 3) patients subsequent to finger separation (n=1). The posterior interosseous vessels were ligated below the level at which the motor branch to the extensor carpi ulnaris crossed the vessel superficially. The recipient vessels were the proper digital artery and palmar subcutaneous vein (n=10), deep branch of the ulnar palm artery (n=1), superficial branch of the radial palm artery (n=1) and the vena comitante. The cosmetic appearance of the donor and recipient sites, static two-point discrimination and active total range of motion of the operated finger were evaluated in a follow-up visit.

All flaps survived completely and all donor sites were closed directly, leaving a linear scar. De-fatting of the flap was carried out in one case in the late postoperative period; all other patients achieved a cosmetically acceptable result. Static two-point discrimination scores averaged 11 mm (range: 8-15 mm). Postoperatively, seven patients maintained normal flexion and extension of the joint. Two patients who had experienced a fracture and flexor injury recovered near-normal flexion and extension after flexor release; the other patients only recovered partially due to severe preoperative joint stiffness. Preoperatively, the active total range of motion of the operated fingers averaged 187 (range: 20-260). The average active total range of motion of the operated fingers at the last follow-up was 210 (range: 60-260). There was a significant difference between the preoperative and follow-up values (p=0.042).

The posterior interosseous free flap may become one valuable option for finger re-surfacing. Avoiding the sacrifice of a main artery of the hand and shorter pedicle can reduce the morbidity and operative time associated with this procedure. In addition, separate regions can be reconstructed with a dual-paddle flap.