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Background: Reverse-flow posterior interosseous artery (rPIA) flap is an excellent tool for restoration of defects in the hand and upper extremity, sparing the main arteries to the hand. Its reliability has been well established. Materials and Methods: Fifty-one cases of rPIA flap involving 49 patients were retrospectively reviewed. The inclusion criteria were age, sex, etiology, size and location of the defect, flap size, number of perforators included, pedicle length, flap inset, donor site coverage, complications, and ancillary procedures. Results: This study included 44 men and 5 women, ranging in age between 10 and 73 years. The subjects had soft tissue defects of the hand and upper extremity mainly due to traumatic injuries, including scar contractures of the first web space in 18 cases, thumb amputations in 6 cases, and congenital defects in 1 case. Among the 51 rPIA flap elevations, 3 cases involved flap failure due to the absence of proper pedicle. A fasciocutaneous pattern was observed in 45 cases and a myocutaneous pattern in 3 cases. In 5 cases of unplantable thumb amputations, the rPIA flap was performed for arterial inflow to the secondary toe-to-thumb transfer. Venous congestion of varying degrees was noted in 7 cases involving partial necrosis in 2 cases. During the mean 17 months of follow-up, patients were generally satisfied with the final outcomes. Conclusion: The rPIA flap can be used not only for soft tissue coverage of the hand and upper extremity but also as a recipient arterial pedicle for a secondary toe-to thumb transfer.

HAND 11(1S) and releases for the upper extremity, in adolescents with spastic hemiplegic cerebral palsy (CP). Material and Methods: Prospective study of 11 patients with spastic hemiplegic CP, 8 men, 4 female, between 10 and 16 years of age (mean, 13 years). Inclusion criteria were no fixed articular deformity and patients capable to follow instructions. Surgery consists in a one-time procedure of tendon transfers and releases according to SHUEE and clinical preoperative evaluation. Surgical procedures were done considering individual evaluations as follows: adductor pollicis (AP) release and extensor pollicis longus (EPL) rerouting, 11 patients; extensor carpi ulnaris (ECU) to extensor carpi radialis longus transfer (ECRL), 6 patients; flexor carpi ulnaris (FCU) to extensor carpi radialis brevis (ECRB) transfer, 3 patients; pronator teres (PT) rerouting, 4 patients; release of the FCU, 3 patients; release of the PT, 4 patients; superficial finger flexor tendons release, 3 patients; and swan deformity correction, 3 patients. Before tendon transfer, muscles were previously assed by dynamic electromyography to confirm phasic behavior. Postoperative protocol includes 1-month cast immobilization followed by 20 sessions of physical therapy, orthotic, and scar compression. Assessment with SHUEE, 12-element stereognosis test, and HOUSE classification (JH House) were done at preoperative, 6 and 12 months after surgery. Results: Friedman analysis of the 3 sections of the SHUEE was done. The spontaneous functional analysis of SHUEE (SFA) improves from 53% preoperative to 62% at 12 month of surgery, which was not significant (P, .12). Dynamic positional analysis (DPA) improves significantly from 53% preoperative to 64% at 6 months and 76% at 12 months of surgery (P, .004), the best result was in wrist and the worse was thumb. There were significant improvements of the grasp and release analysis (GRA) from 82% to 100% at 12 months (P, .002). No significant changes in stereognosis were observed improving from 50% to 75% (P, .05). Functional classification of HOUSE before surgery was 3 to 7. All patients improved their function in HOUSE scale 1 or 2 levels at 6 months and 1 to 3 levels at 12 month. Conclusions: Tendon transfers and releases for the upper extremity in spastic hemiplegic CP adolescents without fixed articular deformities improves dynamic position, grasp and release, and HOUSE level of function.