Anatomical basis of a proximal fasciocutaneous extension of the distal-based posterior interosseous flap that allows exclusion of the proximal posterior interosseous artery

Sun, Chao; Wang, Yulong; Ding, Zhengnian; Liu, Peng; Qin, Xiangzheng; Lee, Hong-liang; Jin, Anmin

doi:10.1016/j.bjps.2014.09.042

Cited by 14 publications

(13 citation statements)

References 31 publications

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“…Subsequently, technical modifications have been described to overcome these problems. Recently, Sun et al 18 performed a cadaveric study of the PIA and septocutaneous perforators to provide the anatomical evidence for clinical use of PIA pedicle cutaneous branch–chain perforator flap. This technique simplifies the dissection; however, it can be used only for the repair of small hand defects up to the metacarpophalangeal joint on the dorsum of the hand.…”

Section: Discussionmentioning

confidence: 99%

Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources

Tiengo¹,

Venezia²,

Lombardi³

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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Purpose:The reverse posterior interosseous artery flap has several advantages, not sacrificing any major blood vessel, but its relatively short pedicle limits the use to cover defects up to the metacarpophalangeal joint. Our purpose is to demonstrate that the ligature of the anterior interosseous artery (AIA), proximal to the communicating branch with the posterior interosseous artery, leads to an improved flap rotation arch, preserving both vascular sources.Methods:Sixteen fresh cadavers with latex perfusion were analyzed before and after our technique of elongation, and the so-obtained measures were standardized in “percentage of elongation of the pedicle.” Eight patient with the loss of substance at the dorsal aspect of the hand have been treated with this technique, and results were evaluated in terms of flap survival and complication rates.Results:The medium length of the pedicle in the normal flap was 10.8 cm, and after the section of the AIA, the medium length of the pedicle was 13.6 cm with a medium increase of 2.8 cm. It means a medium increase of 24% of the length of the pedicle. In all patients treated, full coverage of the defect was obtained, and we did not experience major complications.Conclusions:This anatomical study supported by our clinical experience demonstrates that the use of the variant described above permits to reach more distal part of the hand without being afraid to stretch the pedicle because of the connection with the anastomotic arcades of the AIA at the wrist reducing the risk of ischemia of the flap.

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Section: Discussionmentioning

confidence: 99%

Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources

Tiengo¹,

Venezia²,

Lombardi³

et al. 2016

Plastic and Reconstructive Surgery - Global Open

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show abstract

“…In our cases, the flaps based on only 1 perforator extended to two‐thirds or almost the full length of the forearm from the recurrent branch of the anterior interosseous artery without including other perforators from the posterior interosseous artery, and it survived completely. Although there is no definitive information about the survival area of this flap, the anatomical relationship between the recurrent branch of the anterior interosseous artery and the posterior interosseous artery has been well described in previous reports in the literature (Angrigiani, Grilli, Dominikow, & Zancolli, ; Hubmer et al, ; Sun et al, ). In an extensive cadaveric study, Humber et al performed anatomic and embryologic analysis of the anastomosis between the anterior and posterior interosseous arteries and, based on the diameter of the posterior interosseous artery, concluded that the vascular arcade formed by the dorsal branch of the anterior interosseous artery anastomoses with the posterior interosseous artery via choke vessels in the middle forearm.…”

Section: Discussionmentioning

confidence: 84%

“…Sun et al performed a statistical analysis of the perforator location of the posterior interosseous vascular system. They reported that 2 main clusters of perforators from the posterior interosseous vascular system were located at a distance of 6 ± 2 cm proximal to the head of the ulna and 10 ± 1 cm distal to the lateral epicondyle of the humerus along the axis of the ulnar head‐to‐lateral epicondyle (Sun et al, ). These reports indicate that the cluster of perforators proximal to the head of the ulna is derived from the anterior interosseous vascular system, whereas the cluster of perforators distal to the lateral epicondyle of the humerus is derived from the posterior interosseous vascular system.…”

Section: Discussionmentioning

confidence: 99%

Recurrent branch of anterior interosseous artery perforator‐based propeller flap for distal forearm injuries: Report of 2 cases

et al. 2018

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Despite various options for the reconstruction of soft tissue defects in the distal forearm, perforator‐based propeller flap is rarely used. Here, we presented 2 cases of distal forearm injuries that were repaired using the recurrent branch of anterior interosseous artery perforator‐based propeller flap. Patients in these cases were 57 and 67 years of age. Wounds resulting from farming machine injury and pyogenic extensor tenosynovitis following cat bite wounds were localized to the distal forearm and dorsum of the hand. Defect dimensions were 5 cm × 10 cm and 5 cm × 8 cm. The 12 cm × 7 cm and 21 cm × 4 cm sized recurrent branch of anterior interosseous artery perforator‐based propeller flap was designed adjacent to the wounds. In the latter case, the absence of the posterior interosseous artery in the distal forearm was observed. One perforator from the recurrent branch of the anterior interosseous artery emerged through the septum between the extensor digiti minimi and extensor carpi ulnaris 7.5 cm and 6.0 cm proximal to the ulnar head in cases 1 and 2, respectively. Perforators were identified using multidetector computed tomographic angiography and handheld Doppler. Extending to two‐thirds or almost the full length of the forearm, the flaps were raised and rotated by 90° and 120° to cover the defect. The donor sites were closed using free skin graft. Both flaps survived. Except for minor wound dehiscence and hemarthrosis, no other postoperative complications occurred. Patients returned to work or daily activities at 3‐ and 4‐month follow‐up after surgery.

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“…4 This completes the dissection on ulnar side. Then we take incision on distal and radial borders of flap on proximal forearm till we reach the bridge segment.…”

Section: Identification Of the Nerve To Ecu-mentioning

confidence: 99%

“…Of these six arteries, two are clinically significant perforators (0.5 mm or more in diameter) and are located 6 ± 2 cm proximal to the head of the ulna and 10 ± 1 cm distal to the lateral epicondyle of the humerus. 4 The distal anastomoses of the posterior interosseous artery are classically described as being with the anterior interosseous artery (AIA) and the dorsal carpal network. The anastomosis between the two interosseous arteries is by aconnecting vessel that lies beneath the tendon of extensor indicis proprius at the level of the head of the ulna.…”

Section: Vascular Anatomymentioning

confidence: 99%

Refinements in the surgical technique to harvest distally based posterior interosseous artery flap

Munot¹

2018

jmscr

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Anatomical basis of a proximal fasciocutaneous extension of the distal-based posterior interosseous flap that allows exclusion of the proximal posterior interosseous artery

Cited by 14 publications

References 31 publications

Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources

Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources

Recurrent branch of anterior interosseous artery perforator‐based propeller flap for distal forearm injuries: Report of 2 cases

Refinements in the surgical technique to harvest distally based posterior interosseous artery flap

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