Functional Anconeus Free Flap for Thenar Reconstruction: A Cadaveric Study

Abstract

Background

Restoration of thumb opposition when significant thenar soft tissue defects occur remains a considerable surgical challenge. While several clinical applications of the anconeus muscle have been developed, free functioning muscle transfer (FFMT) of the anconeus for thenar reconstruction has not been reported previously. This study therefore sought to describe anatomical features of the anconeus that would determine its suitability for use as a FFMT.

Methods

The anconeus, its corresponding abductor pollicis brevis (APB), and the supplying neurovasculature in eight white British cadaveric upper extremities were identified and dissected. Measurements were performed using standard calipers and ImageJ 1.45d for a quantitative description of muscle architecture and the neurovasculature involved in the operative planning of the anconeus FFMT.

Results

The mean measures of the anconeus were larger than those of the APB (anconeus/APB fiber length=88.0±9.9/57.7±9.0 mm, area=1,341.9±230.4/987.7±251.2 mm²). There was no significant difference between mean fiber angles (anconeus/APB=70.5±11.9°/78.4±12.2°; p>0.05) and neurovasculature (anconeus/APB: artery diameter=1.9±0.2/2.0±0.5 mm, nerve diameter=1.7±0.3/2.1±0.4 mm; p>0.05). The length (31.3±6.9 mm) and caliber (diameter=1.9±0.2 mm) of the vascular pedicle of the anconeus (recurrent posterior interosseous artery) and its venae comitans (diameter=1.0 mm) are sufficient for microsurgical anastomosis.

Conclusions

The anatomic rationale of the anconeus FFMT for thenar reconstruction is sound and, compared to other FFMTs, may provide several advantages: reliable and matching anatomy, minimal donor site morbidity, and the potential to restore a greater degree of opposition and thus function in a one-stage procedure.

Keywords

Anconeus Thenar reconstruction Free flap Cadaveric study

Get full access to this article

View all access options for this article.

References

Baker

Watson

. Functional gracilis flap in thenar reconstruction. J Plast Reconstr Aesthet Surg 2007;60(7):828–34.

Fleager

Cheung

. The “anconeus slide”: rotation flap for management of posterior wound complications about the elbow. J Shoulder Elbow Surg 2011;20(8):1310–6.

Hwang

Han

Chung

. Topographical anatomy of the anconeus muscle for use as a free flap. J Reconstr Microsurg 2004;20(8):631–6.

Logan

Alpert

Buncke

. Free serratus anterior muscle transplantation for hand reconstruction. Br J Plast Surg 1988;41:639–43.

Loukas

Holdman

. Anatomical variations of the superficial and deep palmar arches. Folia Morphol (Warsz). 2005;64(2):78–83.

Mitz

. Second toe to thumb transfer with extensor digitorum brevis opponensplasty. Ann Plast Surg 1986;17:259–62.

Nishida

Iwasaki

Minami

. Anconeus muscle flap for the treatment of soft tissue defects over the olecranon after total elbow arthroplasty. J Hand Surg Eur 2009;34(4):538–9.

Parry

Ward

Mathes

. Vascular anatomy of the upper extremity muscles. Plast Reconstr Surg 1988;81:358–65.

Ruengsakulrach

Eizenberg

Fahrer

. Surgical implications of variations in hand collateral circulation: anatomy revisited. J Thorac Cardiovasc Surg 2001;122(4):682–6.

10.

Schmidt

Kohut

Greenberg

Kann

Idler

Kiefhaber

. The anconeus muscle flap: its anatomy and clinical application. J Hand Surg Am 1999;24(2):359–69.

11.

Stannard

Schmidt

Kregor

. Surgical treatment of orthopaedic trauma. New York: Thieme; 2007.

12.

Tamai

Fukui

Shimizu

. Thumb reconstruction with an iliac bone graft and a dorsalis pedis flap transplant including the extensor digitorum brevis muscle for restoring opposition: a case report. Microsurgery 1983;4:81–6.

13.

Tubiana

: Prehension in the Mutilated Hand. In Reid

D.A.C

Tubiana

. (eds): Mutilating Injuries of the Hand. Edinburgh, Churchill Livingstone, 1984, p 61.

14.

Gottlieb

. Glabrous dermal grafting: a 12-year experience with the functional and aesthetic restoration of palmar and plantar skin defects. Plast Reconstr Surg 2005;116 (6):1679–85.

15.

Yang

Kim

Lee

Roh

Abdullah

. The radial artery superficial palmar branch flap: a modified free thenar flap with constant innervation. J Reconstr Microsurg 2010;26 (8):529–38.

16.

Zhu

Zhang

Yao

. Free musculocutaneous flap transfer of extensor digitorum brevis muscle by microvascular anastomosis for restoration of function of thenar and adductor pollicis muscles. Ann Plast Surg 1985;15:481–8.