Clinical Example: Excision of thenar area metastasis and cover with a posterior interosseous artery island flap

The posterior interosseous artery flap is useful for resurfacing palm ad dorsal metacarpal skin defects. This case illustrates its use in covering the thenar area.

 
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This elderly gentleman with lung cancer developed a thenar area metastasis. It did not respond to radiotherapy, was painful and foul smelling.
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Radial forearm flap was contraindicated by an occluded radial artery.
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Plan for excision.
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Excision defect.
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Thenar muscles excised. Flexor pollicis longus, flexor carpi radialis and abductor pollicis longus, transverse retinacular ligament and thumb metacarpal are exposed.
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Plan for the dorsal forearm flap.
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Flap inset. A small full thickness graft was used in the central palm.
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Six weeks postoperative, healed and pain free. There were no hand recurrences during the patient's remaining nine months of life.
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Donor site, primary closure.
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