The posterior interosseous flap – a prime technique in hand reconstruction. The experience of 100 anatomical dissections and 102 clinical cases

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

“…19 Moreover, the anastomosis of the AIA and PIA may be absent, and the location and diameter of the septocutaneous perforators can also vary. 2,5,15,20,31 Doppler may be needed for preoperative exploration. Because vasospasm can often occur in small blood vessels when stretched or distorted, traction-applied stress should be avoided when proceeding with vessel anatomy techniques.…”

“…6 Another problem is inadvertent injury to the PIN when dissecting and ligating the PIA near its origin ( Figure 9). 8,19,20 The PIA chain-link perforator flap ( Figure 10) has some advantages in common with the traditional reverse PIA flap (Figure 9), such as good texture, simple operation, ease of survival, and no need for sacrificing the main vessels, 5,8,9,15,16,29 but it also has some unique features. First, it reduces operation time.…”

“…The PIA flap is considered to be an ideal choice to cover any skin defect over the distal forearm, wrist, hand, and fingers 8,15,29 (Figure 9). However, the technical demands of the pedicle dissection, along with the risks of ischemic necrosis and venous congestion, are considered to be major drawbacks of the flap.…”

“…4e19 The disadvantages of this technique include unreliable vascular anatomy as a result of damage to the small vessels or anatomical variations 3,5,15,20 and tedious pedicle dissection. 13 Additionally, because the PIA is proximally accompanied by the posterior interosseous nerve (PIN) in the form of neurovascular bundles, the hazard of cutting the PIN branches increases during pedicle dissection.…”

Möglichkeiten und Ergebnisse der Lappenlastiken aus dem Arteria-interossea-System zur Defektdeckung im Handbereich

“…Die genannten Muskeln werden durch kurze Muskeläste versorgt. Über muskulo-periostale Äste zum M. extensor pollicis longus und M. extensor indicis proprius versorgt die A. interossea posterior auch die mediale Seite der Ulna [6,8]. Im proximalen Unterarmdrittel verläuft der R. profundus nervi radialis mit der A. interossea posterior.…”