Review Article| Volume 60, ISSUE 7, P740-747, July 2007

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


      Based on our experience of 102 clinical cases and 100 anatomical dissections, we have assessed the indications for the posterior interosseous flap in reconstruction of the hand. Large fasciocutaneous island flaps can be harvested, even when the radial or ulnar pedicles are damaged. One real advantage is that the posterior interosseous artery is a vessel of secondary importance for hand vascularisation. Fasciocutaneous and osteofasciocutaneous island distally based flaps can be tailored. The major indications are reconstruction of the first web space up to the interphalangeal joint of the thumb, dorsal hand defects up to the metacarpal joints and large defects on the palm-ulnar border of the hand. It is, therefore, a primary weapon amongst hand reconstruction techniques.


      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


        • Zancolli E.A.
        • Angrigiani C.
        Colgajo dorsal de antebrazo (en isla) (pediculo de vasos interoseos posteriores).
        Rev Assoc Arg Ortop Traumatol. 1986; 54: 161-168
        • Penteado C.V.
        • Masquelet A.C.
        • Chevrel J.P.
        The anatomic basis of the fascio-cutaneous flap of the posterior interosseous artery.
        Surg Radiol Anat. 1986; 8: 209-215
        • Masquelet A.C.
        • Penteado C.V.
        Le lambeaux interosseux postérieur.
        Ann Chir Main. 1987; 6: 131-139
        • Costa H.
        • Soutar D.S.
        The distally based island posterior interosseous flap.
        Br J Plast Surg. 1988; 41: 221-227
        • 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.
        • Comba S.
        • Martins A.
        • et al.
        Further experience with the osterior interosseous flap.
        Br J Plast Surg. 1991; 44: 449-455
        • Biemer E.
        • Stock W.
        Total thumb reconstruction: a one-stage reconstruction using an osteocutaneous forearm flap.
        Br J Plast Surg. 1983; 36: 52-55
        • Foucher G.
        • Genechten F.
        • Merle N.
        • et al.
        A compound radial artery forearm flap in hand surgery: an original modification of the chinese forearm flap.
        Br J Plast Surg. 1984; 37: 139-148
        • Lin S.D.
        • Lai C.S.
        • Chin C.C.
        Venous drainage in the reverse forearm flap.
        Plast Reconstr Surg. 1984; 74: 508-510
        • Reid C.D.
        • Moss L.H.
        One-stage flap repair with vascularised tendon grafts in a dorsal hand injury using the Chinese forearm flap.
        Br J Plast Surg. 1983; 36: 473-479
        • Soutar D.S.
        • Tanner N.S.B.
        The radial forearm flap in the management of soft tissue injuries of the hand.
        Br J Plast Surg. 1984; 37: 18-26
        • Stock W.
        • Muhlbauer W.
        • Biemer E.
        Der neurovaskulare Unterarm-Insel-Lappen.
        Z Plast Chir. 1981; 5: 158-161
        • Glasson D.W.
        • Lovie M.J.
        The ulnar island flap in hand and forearm reconstruction.
        Br J Plast Surg. 1988; 41: 349-353
        • Guimberteau J.C.
        • Goin J.L.
        • Panconi B.
        • et al.
        The reverse ulnar artery forearm island flap in hand surgery: 54 cases.
        Plast Reconstr Surg. 1988; 81: 925-932
        • Zhutian L.
        • Li K.E.
        • Yude C.
        The reverse flow ulnar artery island flap: 42 clinical cases.
        Br J Plast Surg. 1989; 43: 256-259
        • Jones B.M.
        • O'Brien C.J.
        Acute ischaemia of the hand resulting from elevation of a radial forearm flap.
        Br J Plast Surg. 1985; 38: 396-397
        • Timmons M.J.
        • Missotten F.E.M.
        • Poole M.D.
        • et al.
        Complications of radial forearm flap donor sites.
        Br J Plast Surg. 1986; 39: 176-178
      1. Suominen S, Asko-Seljavaara S, Attovuo J. Thermography and color Doppler ultrasonography of hands after radial forearm flap elevation. Presented at the 5th Annual Meeting of the European Association of Plastic Surgeons, May 14, 1994, Geneva, p 95.

      2. Braun JB. Les artéres de la main. Thése, Université de Nancy.

        • Kleinert J.M.
        • Fleming S.G.
        • Abel R.M.C.
        • et al.
        Radial and ulnar artery dominance in normal digiti.
        J Hand Surg. 1989; 14A: 504-508
        • 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
        • Buchler U.
        • Frey H.P.
        Retrograde posterior interosseous flap.
        J Hand Surg. 1991; 16A: 283-292
        • Giunta R.
        • Lukas B.
        Impossible harvest of the posterior interosseous artery flap: a report of an individualised salvage procedure.
        Br J Plast Surg. 1998; 51: 642-645
        • Costa H.
        • Cunha C.
        • Silva A.
        • et al.
        One real advantage of the distally based posterior interosseous island flap.
        Eur J Plast Surg. 1996; 19: 92-99
        • Costa H.
        • Mesquita A.
        • Cunha C.
        • et al.
        Retalho interósseo posterior na cirurgia da mão.
        Rev Port Ortop Traum. 1997; 5: 111-117
        • Costa H.
        The distally based island posterior interosseous flap.
        Br J Plast Surg. 1998; 51: 650-651
        • 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 Jan; 54: 28-33
        • Costa H.
        • Cunha C.
        • Barroso M.L.
        • et al.
        Indicações do retalho interósseo posterior na reconstrução da mão. Experiência de 85 casos clínicos.
        Rev Iberam Cir Mano. 2001; 28: 15-27
        • Chen H.
        • Cheng M.
        • Schneeberger A.G.
        • et al.
        Posterior interosseous flap and its variations for coverage of hand wounds.
        J Trauma. 1998; 45: 570-574
        • Brunelli F.
        • Valenti P.
        • Dumontier C.
        • et al.
        The posterior interosseous reverse flap: experience with 113 flaps.
        Ann Plast Surg. Jul 2001; 47: 25-30
        • Bayon P.
        • Pho R.W.H.
        Anatomical basis of orearm flap based on posterior interosseous vessels.
        J Hand Surg. 1988; 13B: 435
        • Gupta A.
        • Wang A.
        • Baylis W.
        • et al.
        Anterior transposition of the posterior interosseous artery flap through the interosseous membrane.
        J Hand Surg. 1997; 22B: 32-33