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Our experience of Posterior interosseous bone flap reconstruction of segmental defects of hand and distal forearm
Keywords:
Intercalated bone deficits, Posterior interosseous bone island pedicles, Reconstructive surgical procedure.Abstract
ABSTRACT
Objective: To determine the functional and radiological outcome of posterior interosseous bone flap in reconstruction of intercalated defects of the hand and distal forearm.
Methods: This descriptive study was conducted in Millat Orthopedic and Trauma Surgery Hospital Sargodha from 23rd March 2015 to 23rd June 2019.All patients of segmental bone loss in the hand and distal forearm fulfilling the inclusion criteria were treated with posterior interosseous bone island pedicle flaps for filling of defects. Donor site wounds were directly closed. The patients were assessed clinically for viability of the flap and hand functions and radiologically for transferred bone union.
Results: The total number of patients were 6 with mean age 33.3 years(range 19 to 48 years).All patients were male. Right side was involved in 4(66.6% ) and left in 2(33.3% ).The aetiology was gunshot injury in 3(50% ), saw cut in 2(33.3% ) and infection in 1( 16.6% ) patient. First metacarpal bone defect was present in 2 (33.3% ) patients, second and third metacarpal in 1(16.6%),third metacarpal in 1(16.6% ) proximal phalanx of the thumb in 1 (16.6% ) and distal radius in 1 (16.6% ) patient. Posterior interosseous osteocutaneous flap were used in 4(66.6% ) and osseous flap in 2(33.3% ).The mean length of bone transported was 4.3 cm(range 2.5 to 5.5 cm). All flaps survived completely without any untoward sequelae. No donor site morbidity regarding fracture and cosmesis was reported. The transported bone in all cases were incorporated successfully without any resorption. All the patients were able to use their hands for daily activities without any major functional impairment.
Conclusion: The intercalated defects of the hand and distal forearm treated with posterior interosseous bone flap resulted in acceptable functional and radiological outcome. In an injured hand with composite bone defects of metacarpals or proximal phalanges if there is no biological spare part available then the use of posterior interosseous bone island flaps should be the preferred choice for reconstruction.
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