The posterior interosseous artery flap versus the adipofascial radial artery perforator flap in reconstruction of firecracker and homemade bomb blast injuries of the hand

Madhumita Gupta; Prabir Kumar Jash

doi:10.18203/2349-2902.isj20210962

Authors

Madhumita Gupta Department of Plastic Surgery, Medical College and Hospital, Kolkata, West Bengal
Prabir Kumar Jash Department of Plastic Surgery, Medical College and Hospital, Kolkata, West Bengal

DOI:

https://doi.org/10.18203/2349-2902.isj20210962

Keywords:

Adipofascial radial artery perforator flap, Bomb blast injury, Firecracker, Hand, Posterior interosseous artery flap

Abstract

Background: The soft tissues of the radial aspect of the hand are predominantly affected in firecracker and homemade bomb blast injuries. In such cases, regional flap options are quite appealing for defect coverage. We have compared the outcomes of using two pedicled regional forearm flaps in these injuries, the posterior interosseous artery flap (PIAF) and the adipofascial radial artery perforator flap (ARAPF).

Methods: 37 patients underwent reconstruction of the hand with PIAF (20 cases) and ARAPF (17 cases) between January 2014 and December 2019. They were compared with regards to patient demographics, reconstruction techniques, short-term and long-term functional and aesthetic outcomes using the disabilities of the arm, shoulder and hand (DASH) score and the subjective satisfaction score (SSS).

Results: All our flaps survived without any major complications affecting long-term outcome. We found no statistically significant difference between the two flaps in terms of patient demographics, flap paddle size, duration of hospital stay, DASH score and SSS for recipient site. However, significant difference was noted in the duration of surgery, method of donor site closure and SSS for the donor site.

Conclusions: Both the PIAF and ARAPF can be considered in cases of soft tissue defects of the hand from firecracker or bomb blast injuries. Both preserve the major arteries of the hand while still having reliable vascular pedicle.

Metrics

Metrics Loading ...

Author Biographies

Madhumita Gupta, Department of Plastic Surgery, Medical College and Hospital, Kolkata, West Bengal

Plastic Surgery

Prabir Kumar Jash, Department of Plastic Surgery, Medical College and Hospital, Kolkata, West Bengal

Platic Surgery

References

Freitas AD, Pardini AG Jr, Tavares KE, Lima LAA. Pedicled antebrachial flaps to cover skin defects in the hand. Rev Bras Ortop. 1996;28(4):204-8.

Agir H, Sen C, Alagöz S, Onyedi M, Isil E. Distally based posterior interosseous flap: primary role in soft-tissue reconstruction of the hand. Ann Plast Surg. 2007;59(3):291-6.

Jabaley ME, Peterson HD. Early treatment of war wounds of the hand and forearm in Vietnam. Ann Surg. 1973;177:167-73.

US Naval Academy. Military explosives. Fundamentals of naval weapons systems. Federation of American Scientists website. Available at: http://www.fas.org/man/dod-101/navy/docs/fun/part12.htm. Accessed on 13 December 2011.

Hazani R, Buntic RF, Brooks D. Patterns in blast injuries to the hand. Hand. 2009;4(1):44-9.

Adani R, Tarallo L, Marcoccio I, Fregni U. First web-space reconstruction by the anterolateral thigh flap. J Hand Surg Am. 2006;31(4):640-6.

Zancolli EA, Angrigiani C. Posterior interosseous island forearm flap. J Hand Surg Br. 1988;13(2):130-5.

Akyürek M, Safak T, Keçik A. Coverage of a thumb wound and correction of a first web space contracture using a longitudinally split reverse radial forearm flap. Ann Plast Surg. 2001;47(4):453-7.

Foucher G, van Genechten F, Merle N, Michon J. A compound radial artery forearm flap in hand surgery: an original modification of the Chinese forearm flap. Br J Plast Surg. 1984;37(2):139-48.

Sabapathy SR, Venkatramani H, Martin Playa P. The use of pedicled abdominal flaps for coverage of acute bilateral circumferential degloving injuries of the hand. Trauma Case Rep. 2015;1(3-4):25-31.

Liu DX, Wang H, Li XD, Du SX. Three kinds of forearm flaps for hand skin defects: experience of 65 cases. Arch Orthop Trauma Surg. 2011;131(5):675-80.

Campbell DA, Kay SP. The hand injury severity scoring system. J Hand Surg Br. 1996;21(3):295-8.

Wang JQ, Cai QQ, Yao WT, Gao ST, Wang X, Zhang P. Reverse posterior interosseous artery flap for reconstruction of the wrist and hand after sarcoma resection. Orthop Surg. 2013;5(4):250-4.

Onode E, Takamatsu K, Shintani K, Yokoi T, Uemura T. Anatomical origins of radial artery perforators evaluated using color Doppler ultrasonography. J Reconstr Microsurg. 2016;32:594-8.

Saint-Cyr M, Mujadzic M, Wong C, Hatef D, Lajoie AS, Rohrich RJ. The radial artery pedicle perforator flap: vascular analysis and clinical implications. Plast Reconstr Surg. 2010;125:1469-78.

Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14(2):128-46.

Jones NF, Jarrahy R, Kaufman MR. Pedicled and free radial forearm flaps for reconstruction of the elbow, wrist, and hand. Plast Reconstr Surg. 2008;121(3):887-98.

Soucacos PN, Beris AE, Xenakis TA, Malizos KN, Touliatos AS. Forearm flap in orthopaedic and hand surgery. Microsurgery. 1992;13(4):170-4.

Lin SD, Lai CS, Chiu CC. Venous drainage in the reverse forearm flap. Plast Reconstr Surg. 1984;74(4):508-12.

Yamakawa S, Hayashida K. Dorsal hand reconstruction with radial artery perforator-based adipofascial flap. Plast Aesthet Res. 2020;7:24.

Chang SM. The distally based radial forearm fascia flap. Plast Reconstr Surg. 1990;85(1):150-1.

Chang SM, Hou CL, Zhang F, Lineaweaver WC, Chen ZW, Gu YD. Distally based radial forearm flap with preservation of the radial artery: anatomic, experimental, and clinical studies. Microsurgery. 2003;23(4):328-37.

Mahmoud WH. Radial forearm flap versus radial adipofascial perforator based flap for reconstruction of hand soft tissue defects. Don J Med Med Sci. 2015;2(3):19-25.

Pilling T, Govender P. Profile and management of the firework-injured hand. South Afr Fam Pract. 2016;58(2):48-53.

Matshidza, S, Golele, S, Mennen U. Firecracker injuries of the hand. J Bone Joint Surg. 2005;87(B):272.

Al-Najjar OA, Arajy ZY, Jawdat AA. The Distally Based Radial Forearm Flap in Reconstruction of Complex Defects of the Hand. Iraqi Postgrad Med J. 2008;7(1).

de Lima SJ, Domingos da Costa RP, de Oliveira E, Prudente FG, Mendonça MP, et al. Posterior Inyerbone artery flap for covering serious forearm, wrist and hand injuries. Rev Bras Ortop. 2015;44(1):40-5.

Chang SM, Hou CL. The development of the distally based radial forearm flap in hand reconstruction with preservation of the radial artery. Plast Reconstr Surg. 2000;106(4):955-7.

Ignatiadis IA, Giannoulis FS, Mavrogenis AF, Avram AM, Georgescu AV, Perez ML, et al. Ulnar and radial artery based perforator adipofascial flaps. EEX OT. 2008; 59(2):101-8.

Akdağ O, Yıldıran G, Sütçü M, Karameşe M. Posterior interosseous flap versus reverse adipofascial radial forearm flap for soft tissue reconstruction of dorsal hand defects. Ulus Travma Acil Cerrahi Derg. 2018;24(1):43-48.

Lu LJ, Gong X, Lu XM, Wang KL. The reverse posterior interosseous flap and its composite flap: experience with 201 flaps. J Plast Reconstr Aesthet Surg. 2007;60:876-82.

Akinci M, Ay S, Kamiloglu S, Erçetin O. The reverse posterior interosseous flap: A solution for flap necrosis based on a review of 87 cases. J Plast Reconstr Aesthet Surg. 2006;59:148-52.

Maamoun MI, Rizk IN, El Minawi HM, Moharram AN. Adipofascial perforator based reversed flow radial forearm flap for the reconstruction of hand defects. Kasr El Aini J Surg. 2007;8(1):55-62.

Beaton DE, Katz JN, Fossel AH, Wright JG, Tarasuk V, Bombardier C. Measuring the whole or the parts? Validity, reliability, and responsiveness of the disabilities of the arm, shoulder and hand outcome measure in different regions of the upper extremity. J Hand Ther. 2001;14:128-46.