Local muscle flaps of the second and third interosseus space for the treatment of osteomyelitis in the central metacarpal region

Abstract

Both experimental and clinical studies showed that muscle flap transposition is a reliable tool in treating chronic infections of the bone. The major advantage of local muscle flaps is the treatment with well perfused autogenous tissue without using any implants. The primary closure of the operation site and the cure of infection within four weeks allow a short immobilisation time. Nevertheless, the loss of muscle function with a possible functional and aesthetic defect in the donor site has to be accepted. The first dorsal interosseus muscle and the abductor digiti minimi muscle have been used successfully for the treatment of metacarpal osteomyelitis. Osteomyelitis in the central metacarpal bones cannot be treated with these techniques, because of their limited range. We present the muscles of the second and third interosseus space for local pedicled muscle flap transfer. The arterial network in this interosseus spaces and the vascularisation of the dorsal and palmar interosseus muscles allow to harvest muscle flaps with either proximal or distal pedicle. The loss of interosseus muscles in the second and third interosseus space is tolerable from a functional and esthetic point of view. Operative techniques are shown for the elevation of dorsal and palmar interosseus muscle flaps. Two cases of osteomyelitis in the central metacarpal bones, which were treated successfully with the new local interosseus muscle flaps, are reported.