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The free vascularised extensor retinaculum composite flap - an anatomical basis for a new means in reconstruction of complex extensor tendon injuries and its sequele


Sreedharan, Sad and Ross, R and Froelich, JJ and Cuellar, WA and Karanth, S, The free vascularised extensor retinaculum composite flap - an anatomical basis for a new means in reconstruction of complex extensor tendon injuries and its sequele, Australian Hand Surgery Society & American Society for Surgery of the Hand 2016 Combined Meeting, 30 March - 2 April, 2016, Sydney, Australia (2016) [Conference Extract]

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INTRODUCTION: Complex digital extensor tendon injuries are frequently associated with long-term reduction in hand function. Such injuries may result in deposition of dense scar tissue throughout anatomical tissue planes, adhesion formation between injured structures and contracture of the extensor mechanism. While reconstruction of individual anatomical components is feasible, re-establishing a gliding plane for tendon excursion remains a challenge. The present study aimed to demonstrate the microvascular supply to a composite flap comprising skin, subcutaneous tissue and extensor retinaculum including the intervening areolar gliding planes as a single unit for reconstruction of compound extensor injuries to the hand.

METHODS: An anatomical study was performed comprising the upper limbs (n=18) of fresh frozen cadavers. The anterior interosseous artery (n=9) or posterior interosseous artery (n=9) was selectively cannulated at the origin and injected with coloured dye for microvascular dissection of the proposed flap tissue at the extensor retinaculum. The vessels were then injected with a radiopaque medium for time-rendered digital subtraction angiography and cone-beam computed tomography angiography with multiplanar reconstructions to visualise the patterns of microvascular perfusion of the extensor retinaculum and overlying integument.

RESULTS: Both the anterior and posterior interosseous arteries contributed vascular supply to the extensor retinaculum, demonstrating a dense network of vessels associated with this structure. The anterior interosseous artery was consistently the dominant vessel, perfusing large perforator vessels through the septum between the second and third as well as the fourth and fifth extensor compartments. The posterior interosseous artery supplied perforator vessels to the fourth and fifth extensor compartment and overlying skin, in addition to the well described proximal forearm angiosome territory. Both posterior and anterior interosseous arteries supplied vessels located between fourth and fifth extensor compartments.

Item Details

Item Type:Conference Extract
Keywords:Extensor Retinaculum, extensor tendon, composite free flap, gliding plane, vascularised tendon graft
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Surgery
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Sreedharan, Sad (Mr Sadhishaan Sreedharan)
UTAS Author:Froelich, JJ (Professor Jens Froelich)
UTAS Author:Cuellar, WA (Dr William Cuellar)
ID Code:107913
Year Published:2016
Deposited By:Medicine
Deposited On:2016-03-31
Last Modified:2016-04-01

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