| 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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