Spare Parts Surgery with a Free Posterior Interosseous Artery Perforator Flap for Thumb Tip

Abstract

Summary: Replantation is an ideal method for treating fingertip amputation. However, in some cases, replantation is known to be a challenging issue. This report described a successful thumb tip reconstruction performed with bone and nail bed salvaged as spare parts, and a free posterior interosseous artery perforator (PIAP) flap. A 75-year-old man accidentally amputated his left thumb with an electric saw, and emergency replantation was started under brachial plexus block. However, the distal stump of digital artery was unable to be identified, forcing the initial plan to change to flap reconstruction. After vascular anastomosis, complex tissue containing nail bed and side nail fold was grafted on the adipofascial tissue of PIAP flap. Both PIAP flap and the complex tissue survived completely. At 12 months after surgery, only a slight deformity in the nail plate was observed. Spare parts surgery is a surgical procedure effectively salvaging and utilizing tissue that is going to be discarded in severe limb trauma. This idea can be applied to treatment for the finger amputation. In this case, replantation would be difficult in the thumb tip amputation, so spare parts surgery was performed with a PIAP flap. The innervated PIAP flap is reported, including the posterior antebrachial cutaneous nerve. In this case, the cutaneous nerve was able to be identified, neurorrhaphy was performed, and sufficient sensory recovery was obtained. Surgical procedure with PIAP flaps was found to be a useful method for immediate reconstruction with salvaged spare parts after fingertip replantation was considered to be difficult intraoperatively.

Transplantation of a free fillet flap from discarded fingers for repair of a finger pulp skin defect: a case report

“…In severe hand trauma, the initial surgical treatment plan is critical for the final outcome ( 7 ). For finger amputations, replantation represents the ideal treatment ( 8 ). Another treatment option is to remove tissue from other parts of the body for repair and reconstruction when the injured limb tissue is missing.…”

Three-dimensional computed tomography angiography fusion imaging for posterior interosseous artery perforator location of forearm flap: a retrospective study of 23 patients

“…Forearm ap has been widely recognized for early discovery of its clinical value in repairing upper and lower limb injuries, making it a frequently used option. [1][2][3][4][5][6][7][8] Currently, the perforator is con rmed as the blood supply to the forearm ap.…”