Summary
Objective
To introduce our experiences of using the reverse posterior interosseous flap and
its composite flap.
Methods
In the series of 201 cases, the fasciocutaneous flap was used to cover skin defects
over the distal 1/3rd forearm, wrist and hand in 174 cases. The composite flap with
the vascularised ulna bone graft was used to reconstruct the thumbs in 11 cases, and
with the vascularised tendon graft was used to repair tendon defects with skin defects
in 16 cases. The size of the ulna graft was 3–6 cm in length and 1–2 cm in width. The 4–7 cm tendon graft was obtained from the extensor digiti quinti or extensor carpi ulnaris.
The size of the flaps ranged from 5 cm×4 cm to 16 cm×10 cm.
Results
One flap failed completely. Of the other 200 flaps which survived 16 cases had venous
congestion and had partial necrosis at the distal end. The size of the necrotic area
ranged from 1 to 4 cm in length. Ninety-three patients were followed up for at least 6 months, and included
10 patients with composite flaps. Generally, the flap matched the surrounding skin.
But 10 cases had a lipectomy. The sensibility did not recover or achieved S1 within
6 months. For the extensor tendon defect, the function of finger extension was nearly
normal and tenolysis was not required. In contrast, tenolysis was required after the
flexor tendon reconstruction. However, these patients refused surgery. The bone grafts
were healed in 3 months. The reconstructed thumb looked abnormal and lacked normal
sensibility, although the patients used them. The linear scar line was conspicuous
over the dorsum of the forearm.
Conclusion
The reverse posterior interosseous flap is a reliable method to cover skin defects
over the distal 1/3rd of the forearm, the wrist and hand. The composite flap with
a vascularised tendon graft is an optimal reconstructive option for any extensor tendon
loss (III zone) associated with a skin defect. Using the composite flap with a vascularised
bone graft or combined with the digital neurovascular flap is another way to reconstruct
the thumb.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The posterior interosseous flap: a report of 6 cases.The Second Symposium of the Chinese Association of Hand Surgery (Qing Dao city). 1986; : 187-191
- The anatomic basis of the fasciocutaneous flap of the posterior interosseous artery.Surg Radiol Anat. 1986; 8: 209-215
- Thumb reconstruction by the posterior interosseous osteocutaneous flap.Br J Plast Surg. 1988; 41: 228-233
- The distally based island posterior interosseous flap.Br J Plast Surg. 1988; 41: 221-227
- Posterior interosseous island forearm flap.J Hand Surg (Br). 1988; 13: 130-135
- Anatomical basis of dorsal forearm flap. Based on posterior interosseous vessels.J Hand Surg (Br). 1988; 13: 435-439
- Further experience with the posterior interosseous flap.Br J Plast Surg. 1991; 44: 449-455
- The distally based posterior interosseous island flap for the coverage of skin loss of the hand.Ann Plast Surg. 1991; 27: 527-536
- Posterior interosseous reverse forearm flap: experience with 80 consecutive cases.Plast Reconstr Surg. 1993; 92: 285-293
- Distally based posterior interosseous island flap.Br J Plast Surg. 1995; 48: 258
- The posterior interosseous forearm island flap for skin defects in the hand and elbow. A prospective study of 51 cases.J Hand Surg (Br). 1996; 21: 237-243
- The distally based posterior interosseous fasciocutaneous island flap in reconstruction of the hand in leprosy.Indian J Lepr. 1997; 69: 93-100
- The posterior interosseous flap: a review of 81 clinical cases and 100 anatomical dissections – assessment of its indications in reconstruction of hand defects.Br J Plast Surg. 2001; 54: 28-33
- Antebrachial reverse island flap with pedicle of posterior interosseous artery: a report of 90 cases.Br J Plast Surg. 2004; 57: 645-652
- The posterior interosseous reverse flap: experience with 113 flaps.Ann Plast Surg. 2001; 47: 25-30
- The reverse posterior interosseous flap: a solution for flap necrosis based on a review of 87 cases.J Plast Reconstr Aesthet Surg. 2006; 59: 148-152
Article info
Publication history
Published online: February 02, 2007
Accepted:
November 29,
2006
Received:
March 27,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
