The Reverse Posterior Interosseous Artery Flap: Technical Considerations in Raising an Easier and More Reliable Flap

Acharya, Abhijith; Bhat, Anil K.; Kumar, Bhaskaranand

doi:10.1016/j.jhsa.2011.12.031

Cited by 42 publications

(24 citation statements)

References 16 publications

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“…Such a planning provides us the opportunity to include more perforators to the flap arising from the distal portion of posterior interosseous artery and is a reliable guide for marking the distal limit of flap. Elongation of the distal border of flap (1,11) into the distal third territory for one or two centimetres, improves flap survival rates both because of the additional arterial supply by numerous perforators from posterior interosseous artery (1) and also because of the presence of rich vascular plexus in that region which improves venous drainage (11) . In our previous series of posterior interosseous flap, there was a higher overall (total and partial) flap necrosis rate (10.4%) (1).…”

Section: Discussionmentioning

confidence: 99%

Technical tips in reverse flow posterior interosseous artery flaps

Tenekeci¹,

Akinci²,

Ünal³

2017

J Turgut Ozal Med Cent

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Objective: For avoiding contracture formation, coverage of exposed tendons, bones, nerves, joints or vascular structures, flaps are preferred over other soft tissue reconstruction techniques used in hand. Reverse flow posterior interosseous flaps as an option in hand reconstruction and the ways to obtain higher survival rates based on our experience is described and discussed in this article. Materials and Methods: From July 2003 to June 2013, 45 patients aged between 7 and 69 years (mean 34.6 years) were operated for soft tissue reconstruction of hand using distally based posterior interosseous flap. Results: Operative plan was changed ın one out of 45 flaps due to small pedicle calibre. Only one of the flaps was totally necrosed. No partial necrosis was seen. Conclusion: Reliability of posterior interosseous flaps are sometimes unpredictable due to the anatomical variability of posterior interosseous artery. We do not attempt to make pedicle dissection more proximal to the midpoint of dorsal axis line. Extension of the distal part of reverse flow posterior interosseous flap into the distal third territory is strongly recommended in every case, especially for more distant defects. By doing so, we include a piece of skin with numerious septocutaneous perforators arriving from posterior interosseous artery and their accompanying veins in the distal third region, thus obtaining higher survival rates.We believe that reverse flow posterior interosseous flaps are reliable in reconstruction of hand defects and the application of those operative techniques used in this study improve flap survival rates.

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Section: Discussionmentioning

confidence: 99%

Technical tips in reverse flow posterior interosseous artery flaps

Tenekeci¹,

Akinci²,

Ünal³

2017

J Turgut Ozal Med Cent

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“…13,30 The operative technique was modified by Vinita Puri et al 13 in 2007. They preoperatively ascertained with Doppler ultrasonography that the anastomosis between the AIA and PIA was raised straightway, which saved precious tourniquet time.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, they raised the flap as a septofasciosubcutaneous pedicle flap and included a large amount of fascia and subcutaneous tissue with the flap. To raise an easier and more reliable PIA flap, Acharya et al 30 concluded that technical details should be considered, including performing a proximo-distal flap dissection with the deep fascia, creating a broad pedicle with a cutaneous handle, and avoiding its tunneling for inset. Therefore, to improve the survival of a reverse PIA pedicle chain-link perforator flap, we suggest that the flap could be raised with the deep fascia by dissecting from the proximal to the distal end, followed by the pedicle dissection in the distal third of the forearm.…”

Section: Discussionmentioning

confidence: 99%

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

Sun

Wang

Ding

et al. 2015

Journal of Plastic, Reconstructive & Aesthetic Surgery

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“…The freed forearm posterior interosseous artery perforator flap used to repair hand skin and soft tissue defects can avoid damage of the main blood vessel, providing the flap with a thinner profile and a reliable blood supply. At present, the freed forearm dorsal interosseous artery perforator flap has been broadly applied in repairing regions between the thumb and index fingers, back of the hand, palm, wrist, thumb and even finger trauma and congenital defects [23][24][25][26]. This report describes the successful use of the modified innervated posterior interosseous free perforator flap for the repair of digital defects.…”

Section: Discussionmentioning

confidence: 99%

Use of Free Modified Innervated Posterior Interosseous Artery Perforator Flap to Repair Digital Skin and Soft Tissue Defects

Song

et al. 2014

Indian J Surg

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Current techniques to reconstruct soft tissue of the fingers result in scarring and functional deficits. Perforator flaps raised on the posterior interosseous artery are thin and well vascularised, and cause minimal donor site scarring. Using a flap with sensory nerves was hoped to contribute to the desired postoperative sensory recovery of fingers. We used modified innervated posterior interosseous perforator flaps to repair digital defects in 18 patients. Injuries included digit amputations and palmar soft tissue defects. The posterior antebrachial cutaneous nerve was carried in the flap and bridged with the defect section of the proper digital nerve. The flaps used measured 10 cm×6 cm to 5 cm×3 cm. All 18 flaps survived; one necrotic edge eventually healed. During the 10-28 months of follow-up (average, 14 months), twopoint discrimination in flaps and injured fingers was 6-15 mm. Good functional and sensory outcomes were obtained in primary operation, and patients were generally satisfied with the aesthetic results. Further work will be needed to assess the branches of the posterior interosseous artery preoperatively to improve surgical planning.

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The Reverse Posterior Interosseous Artery Flap: Technical Considerations in Raising an Easier and More Reliable Flap

Cited by 42 publications

References 16 publications

Technical tips in reverse flow posterior interosseous artery flaps

Technical tips in reverse flow posterior interosseous artery flaps

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

Use of Free Modified Innervated Posterior Interosseous Artery Perforator Flap to Repair Digital Skin and Soft Tissue Defects

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