[1]First Hospital of Jilin University, Changchun, China.
Introduction: Severe postburn contracture of the first web space is one of the most common deformities in hand. The contracture will significantly reduce the hands ability to grasp and similarly diminish the ability of the thumb to function appropriately An adequate release of the first web is vital in optimizing hand function. As the merits of reverse posterior interosseous flap (RPIF), it has been widely used to recover the hand defects. But this flap has not well described to be used to release the contracture of the first web space Methods: From 2008 November to 2011 April, twelve consecutive patients (8 males and 4 females) with severe postburn contracture of first web space were enrolled in this study, their age ranged from 15 to 42 years (mean, 33 years), thumb index angle was 23 degrees (10-35 degrees). 17 RPIF were performed under general anesthesia, flap sizes ranged between 18×8cm2 and 10×6cm2, the average size was 113cm2 Results: The follow-up period ranged from 5 months to 26 months, with an average of 17 months. All flaps survived completely and were rapidly adapted to the recipient beds to achieve good color and texture harmonies. None early complications occurred, including venous congestion, arterial insufficiency, suture detachment, and infection. Fifteen donor sites were recovered by skin grafting, the remained two donor sites were healed with direct closure. No paralysis of the posterior interosseous nerve was observed in any of the cases. Measurement of first web angle in the last follow-up, thumb index angle was 78 degrees, increasing the web length of 260%. All patients were able to gain fundamental hand functions for daily routine activities Conclusions: Most of severe postburn contracture of the first web space are the indications need to be released with flaps. The RPIF have some considerable advantages involving thin and pliable structure, perfect color, and texture match to provide a fairly abundant tissue, wide arc of rotation, not to sacrifice a major artery in the hand, and not to interfere with lymphatic and venous drainages of the hand. While the drawbacks are its large donor defects requiring skin grafts and the dissection need be careful and skillful Applicability of Research to Practice: We suggest that the RPIF be used as reliable choice for releasing the severe postburn contracture of the first web space. (Figure Presented).
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