RESUMEN
We present a case report of a failed posterior interosseous flap with distal pedicle rescued by an extensor digiti minimi (EDM) island pedicle flap supplied by the posterior interosseous artery (PIOA) in reverse flow to cover a soft tissue defect in the hand of a 25-year-old man. We subsequently performed an anatomical study on 5 cadaver limbs to determine the EDM muscle's vascularization: it was segmental, multiple and came from the PIOA. The rotation arc reached the dorsal side of the metacarpophalangeal (MCP) joints, as well as the distal part of the thumb. The indications selected are the same as those of the distal pedicle flap: defect on dorsal side of the hand and MCP joints, coverage of carpal tunnel, failure of posterior interosseous flap. This study describes a new flap and adds to our understanding of the EDM muscle's vascularization.
Asunto(s)
Traumatismos de la Mano/cirugía , Músculo Esquelético/irrigación sanguínea , Músculo Esquelético/trasplante , Colgajos Quirúrgicos , Adulto , Arterias/anatomía & histología , Cadáver , Humanos , MasculinoRESUMEN
Anterior chest wall deformity are mostly represented by pectus excavatum, which is a depression of the chondrosternal plastron from the 3rd to the 7th pairs of the costal cartilages, then by pectus carinatum which conversely represents a protrusion of this plastron. The major esthetic and psychosocial impact is not to be demonstrated anymore whereas the cardiopulmonary functional impact remains still highly debated. Regarding the management, curative surgical techniques such as Wurtz's sub-perichondrial simplified sternochondroplasty or Nuss' minimaly invasive technique are opposed to palliative filling technique such as customized silicone implant, lipostructure and flaps. In addition to these there are non-surgical techniques like suction bells (Vacuum Bell®) for pectus excavatum or compressive orthotic bracing for pectus carinatum. The morbidity and the mortality related to some of the heavy surgeries must be weighed up with esthetic, functional or both surgical indications in order to choose the proper management. The other known deformities are much rarer. Pectus arcuatum is a combined type requiring the same management principles. Sternal cleft is caused by a fusion defect of the sternal bars, which must be treated mainly by neonatal surgery. Acquired restrictive thoracic dystrophy is a consequence of early curative surgery.