“Posterior interosseus artery flap for hand reconstruction: anatomical basis and clinical application”

Abstract

Summary Flap options for upper limb reconstruction have increased due to better understanding of its vascular anatomy. The posterior interosseus artery flap (PIAF) is used to cover defects of the wrist, hand, proximal thumb, and first web space. This flap has many advantages but requires good knowledge about the anatomy of the posterior interosseus artery (PIOA) and its perforators. Methods Twenty upper extremity cadaveric specimens were injected with red latex, Fine dissection of the PIOA and its perforators took place; the perforators were counted, measured, described and photographed. Twenty patients with dorsal hand defects, had PIAF. Cases have Post-operative care and followed up for 6 months post-operative. Results The PIOA was constant in all cadaveric dissections and gave off 4–8 septocutaneous perforators along its course between the extensor carpi ulnaris (ECU) and extensor digitorum (EDM) muscles. The mean distance of the distal most perforator in the middle third forearm from the ulnar styloid was 10.39 ± 1.54 cm. The anastomosis between the PIOA and the anterior interosseus artery (AIOA) was there in all specimens. Venous congestion occurred in 10% of the cases and was managed conservatively. Necrosis of the distal third of the flap was inevitable in one case; excellent results were obtained in the other cases 90%. Conclusions The posterior interosseus artery flap is an excellent perforator flap for hand reconstruction preserving the ulnar and radial artery; but it has a possible complications such as venous congestion or partial flap necrosis that could be managed conservatively. Level of evidence II.

A treatment algorithm for reconstruction of soft tissue defects in the hand: a narrative review

“…Skin grafts in general, are suitable only if the wound bed is vascularized including a thin vascular plane covering the extensor tendons (paratenon) and the defect size is not too large [small (<2 cm × 2 cm) – medium ( >2 cm × 2 cm)] ( 29 ). For medium sized defects, the dorsal aspect of the hand can be covered by the pedicled posterior interosseus artery flap, the distal ulnar artery perforator flap, or if a major artery can be sacrificed, the reverse radial forearm flap ( 30 - 32 ).…”

“…For medium sized (>2 cm × 2 cm) and large (>4 cm × 4 cm) defects, the palm can be covered readily by pedicled flaps or microvascular options. Examples of pedicled flaps include the reverse radial forearm and ulnar artery perforator flaps ( 30 , 31 ). Free style rotational perforator flaps permit reconstruction of even large defects without microsurgical anastomosis.…”

Versatile clinical application of radial artery perforator flap for hand and wrist reconstruction

“…The main disadvantage of this flap is shorter pedicle length. Posterior interosseus flap is also very useful for hand reconstruction 33 . Technically demanding dissection and perfusion which is dependent on an adequate distal communication between the anterior and posterior interosseous arteries are the reasons why it is less often used in daily clinical practice.…”

Concepts in soft-tissue reconstruction of the contracted hand and upper extremity after burn injury

“…The reverse posterior interosseous flap can also be designed is a flap which also does not sacrifice a major vessel and can be used to reach to the thumb or first webspace. However intact flow through the anterior interosseous artery must be present, and venous congestion is a known complication ( 41 ).…”