Research Article| Volume 60, ISSUE 8, P876-882, August 2007

Download started.


The reverse posterior interosseous flap and its composite flap: Experience with 201 flaps

Published:February 02, 2007DOI:



      To introduce our experiences of using the reverse posterior interosseous flap and its composite flap.


      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.


      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.


      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.


      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 access
      One-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 to Journal of Plastic, Reconstructive & Aesthetic Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Lu L.J.
        • Wang S.F.
        • Yang J.
        • et al.
        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
        • Penteado C.V.
        • Masquelet A.C.
        • Chevrel J.P.
        The anatomic basis of the fasciocutaneous flap of the posterior interosseous artery.
        Surg Radiol Anat. 1986; 8: 209-215
        • Costa H.
        • Smith R.
        • McGrouther D.A.
        Thumb reconstruction by the posterior interosseous osteocutaneous flap.
        Br J Plast Surg. 1988; 41: 228-233
        • Costa H.
        • Soutar D.S.
        The distally based island posterior interosseous flap.
        Br J Plast Surg. 1988; 41: 221-227
        • Zancolli E.A.
        • Angrigiani C.
        Posterior interosseous island forearm flap.
        J Hand Surg (Br). 1988; 13: 130-135
        • Bayon P.
        • Pho R.W.
        Anatomical basis of dorsal forearm flap. Based on posterior interosseous vessels.
        J Hand Surg (Br). 1988; 13: 435-439
        • Costa H.
        • Comba S.
        • Martins A.
        • et al.
        Further experience with the posterior interosseous flap.
        Br J Plast Surg. 1991; 44: 449-455
        • Landi A.
        • Luchetti R.
        • Soragni O.
        • et al.
        The distally based posterior interosseous island flap for the coverage of skin loss of the hand.
        Ann Plast Surg. 1991; 27: 527-536
        • Angrigiani C.
        • Grilli D.
        • Dominikow D.
        • et al.
        Posterior interosseous reverse forearm flap: experience with 80 consecutive cases.
        Plast Reconstr Surg. 1993; 92: 285-293
        • Richard B.M.
        Distally based posterior interosseous island flap.
        Br J Plast Surg. 1995; 48: 258
        • Mazzer N.
        • Barbieri C.H.
        • Cortez M.
        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
        • Teo T.C.
        • Richard B.M.
        The distally based posterior interosseous fasciocutaneous island flap in reconstruction of the hand in leprosy.
        Indian J Lepr. 1997; 69: 93-100
        • Costa H.
        • Gracia M.L.
        • Vranchx J.
        • et al.
        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
        • Lu L.J.
        • Gong X.
        • Liu Z.G.
        • et al.
        Antebrachial reverse island flap with pedicle of posterior interosseous artery: a report of 90 cases.
        Br J Plast Surg. 2004; 57: 645-652
        • Brunelli F.
        • Valenti P.
        • Dumontier C.
        • et al.
        The posterior interosseous reverse flap: experience with 113 flaps.
        Ann Plast Surg. 2001; 47: 25-30
        • Akinci M.
        • Ay S.
        • Kamiloglu S.
        • et al.
        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