Advertisement

Reverse posterior interosseous flap: different approaches over the years – A systematic review

      SUMMARY

      The posterior interosseous flap (PIOF), as fasciocutaneous flap, represents an interesting option in reconstructive surgery of the upper limb. The PIOF allows coverage of losses of substance of the dorsal side of the hand and, with technical modifications, up to the proximal interphalangeal (PIP) joint without any need of microsurgical technique or the sacrifice of the main vascular axes for the hand. Its dimensions can reach up to 22 cm x12 cm and have excellent versatility since it can incorporate vascularized bone grafts and tendon grafts for complex substance losses. Despite the above-mentioned advantages, among the factors that limit its diffusion, indeed, there is the complex dissection technique originally described. Several authors also report a variable incidence of venous congestion, attributing it to the reverse flow vascularity of the flap. However, in the hands of experienced surgeons, this flap has a negligible incidence of complications. For these reasons, the authors performed a systematic review of the literature to organize the various technical updates over the years to extend the indications of the PIOF and reduce the incidence of complications, thus providing a valuable tool for reconstructive surgeons.

      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 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:

      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

      References

        • Zancolli EA
        • Angrigiani C.
        Posterior interosseous island forearm flap.
        J Hand Surg. 1988; 13: 130e135
        • Penteado CV
        • Masquelet AC
        • Chevrel JP.
        The anatomic basis of the fasciocutaneous flap from the posterior interosseous artery.
        Surg Radiol Anat. 1986; 8: 209e215
        • Masquelet AC
        • Penteado CV.
        The posterior interosseous flap.
        Ann Chir Main. 1987; 6: 131-139
        • Ashok S.
        Gavaskar Posterior Interosseous Artery Flap for Resurfacing Posttraumatic Soft Tissue Defects of the Hand.
        Hand (N Y). Dec 2010; 5 (Published online 2010 Apr 20): 397-402
        • Kola N.
        • Isaraj S.
        • Xhepa G.
        • Belba M.
        • Belba G.
        Posterior Interosseous Forearm Flap in Reconstruction of First Web Space.
        Ann Burns Fire Disasters. 2009 Jun 30; 22: 104-106
        • Sun C
        • Wang YL
        • Ding ZH
        • Liu P
        • Qin XZ
        • Lee HL
        • Jin AM.
        Anatomical basis of a proximal fasciocutaneous extension of the distal-based posterior interosseous flap that allows exclusion of the proximal posterior interosseous artery.
        J Plast Reconstr Aesthet Surg. 2015; 68: 17e25
        • Angrigiani C
        • Grilli D
        • Dominikow D
        • Zancolli EA.
        Posterior interosseous reverse forearm flap: experience with 80 consecutive cases.
        Plast Reconstr Surg. 1993; 92: 285e293
        • Acharya AM
        • Bhat AK
        • Bhaskaranand K.
        The reverse posterior interosseous artery flap: technical considerations in raising an easier and more reliable flap.
        J Hand Surg Am. 2012; 37: 575e582
        • Nikkhah D
        • Pickford M.
        Techniques to enable identification and safe elevation of the posterior interosseous artery flap.
        J Plast Reconstr Aesthet Surg. 2018; 71: 1816e1834
        • Cavadas PC
        • Thione A
        • Rubí C.
        The Simplified Posterior Interosseous Flap.
        J Hand Surg Am. 2016; 41: 303e307
        • Nikkhah D
        • Pickford M.
        Techniques to enable identification and safe elevation of the posterior interosseous artery flap: Part 2.
        J Plast Reconstr Aesthet Surg. Jun 2019; 72: 1030-1048
        • El-Sabbagh AH
        • Zeina AA
        • El-Hadidy AM
        • El-Din AB.
        Reversed posterior interosseous flap: safe and easy method for hand reconstruction.
        J Hand Microsurg. Dec 2011; 3: 66-72
        • Bayon P
        • Pho RW.
        Anatomical basis of dorsal forearm flap based on the posterior interosseous vessels.
        J Hand Surg Br. 1988; 13: 435e439
        • Keogh A
        • Graham DJ
        • Tan B.
        Posterior interosseous artery pedicle flap: an anatomical study of the relationship between the posterior interosseous nerve and artery.
        J Hand Surg Eur Vol. Dec 2018; 43: 1050-1053
        • Costa H
        • Pinto A
        • Zenha H.
        The posterior interosseous flap-a prime technique in hand reconstruction: the experience of 100 anatomical dissections and 102 clinical cases.
        J Plast Reconstr Aesthet Surg. 2007; 60: 740e747
        • Lu LJ
        • Gong X
        • Lu XM
        • Wang KL.
        The reverse posterior interosseous flap: experience with 201 flaps.
        J Plast Reconstr Aesthet Surg. 2007; 60: 876e882
        • Costa H
        • Soutar DS.
        The distally based island posterior interosseous flap.
        Br J Plast Surg. 1988; 41: 221-227
        • Mei J
        • Morris SF
        • Ji W
        • Li H
        • Zhou R
        • Tang M
        An anatomic study of the dorsal forearm perforator flaps.
        Surg Radiol Anat. 2013; 35: 695-700
        • Balakrishnan G
        • Kumar BS
        • Hussain SA.
        Reverse-flow posterior interosseous artery flap revisited.
        Plast Reconstr Surg. 2003; 111: 2364-2369
        • Yazar S
        • Chen HC
        • Mardini S.
        Augmentation of venous drainage by a venous anastomosis for pedicled flaps.
        J Reconstr Microsurg. 2008; 24: 369-376
        • Xu G
        • Lai-jin L.
        Coverage of skin defects in spaghetti wrist trauma: application of the reverse posterior interosseous flap and its anatomy.
        J Trauma. 2007; 63: 402-404
        • Tan O.
        Reverse posterior interosseous flap in childhood: a reliable alternative for complex hand defects.
        Ann Plast Surg. 2008; 60: 618-622
        • Cavadas PC
        • Ibañez J
        • Landin L
        • Roger I.
        Use of the reversed posterior interosseous flap in staged reconstruction of mutilating hand injuries before toe transfers.
        Plast Reconstr Surg. 2008; 122: 1823-1826
        • Acharya AM
        • Bhat AK
        • Bhaskaranand K.
        The reverse posterior interosseous artery flap: technical considerations in raising an easier and more reliable flap.
        J Hand Surg Am. 2012; 37: 575-582
        • Cheema TA
        • Lakshman S
        • Cheema MA
        • Durrani SF.
        Reverse-flow posterior interosseous flap-a review of 68 cases.
        Hand (N Y). 2007; 2: 112-116
        • Shahzad MN
        • Ahmed N
        • Qureshi KH.
        Reverse flow posterior interosseous flap: experience with 53 flaps at Nishtar Hospital, Multan.
        J Pak Med Assoc. 2012; 62: 950-954
        • Fong PL
        • Chew WY.
        Posterior interosseous artery flap: our experience and review of modifications done.
        Hand Surg. 2014; 19: 181-187
        • Özalp B
        • Elbey H
        • Aydin A
        • Özkan T.
        Distally based subcutaneous veins for venous insufficiency of the reverse posterior interosseous artery flap.
        Microsurgery. 2016; 36: 384-390
        • Dap F
        • Dautel G
        • Voche P
        • Thomas C
        • Merle M
        The posterior interosseous flap in primary repair of hand injuries. A review of 23 cases.
        J Hand Surg Br. 1993; 18: 437-445
        • Shibata M
        • Iwabuchi Y
        • Kubota S
        • Matsuzaki H.
        Comparison of free and reversed pedicled posterior interosseous cutaneous flaps.
        Plast Reconstr Surg. 1997; 99: 791-802
        • Mazzer N
        • Barbieri CH
        • 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
        • Büchler U
        • Frey HP.
        Retrograde posterior interosseous flap.
        J Hand Surg Am. 1991; 16: 283-292
        • Prasad R
        • Balakrishnan TM.
        Role of Interosseous Recurrent Artery Perforators in the Posterior Interosseous Artery Flap.
        J Hand Microsurg. 2015; 7: 36-41
        • Mago V.
        Retrograde posterior interosseous flap.
        Iowa Orthop J. 2007; 27: 58-60
        • Sananpanich K
        • Tu YK
        • Kraisarin J
        • Chalidapong P.
        Reconstruction of limb soft-tissue defects: using pedicle perforator flaps with preservation of major vessels, a report of 45 cases.
        Injury. 2008; 39: 55-66
        • Reyad KA
        • Shaker AA
        • Elbarbary AS
        • Sayed MA
        • Elghareeb MA.
        The Number of Perforators Included in Reversed Flow Posterior Interosseous Artery Flap: Does It Affect the Incidence of Venous Congestion?.
        Plast Reconstr Surg Glob Open. 2016; 4 (Published 2016 Dec 22): e1162
        • Akinci M
        • Ay S
        • Kamiloglu S
        • Erçetin O.
        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
        • Agir H
        • Sen C
        • Alagöz S
        • Onyedi M
        • Isil E.
        Distally based posterior interosseous flap: primary role in soft-tissue reconstruction of the hand.
        Ann Plast Surg. 2007; 59: 291-296
        • Gong X
        • Lu LJ.
        Reconstruction of severe contracture of the first web space using the reverse posterior interosseous artery flap.
        J Trauma. 2011; 71: 1745-1749
        • Zhang YX
        • Qian Y
        • Pu Z
        • et al.
        Reverse bipaddle posterior interosseous artery perforator flap.
        Plast Reconstr Surg. 2013; 131: 552e-562e
        • Landi A
        • Luchetti R
        • Soragni O
        • De Santis G
        • Sacchetti GL.
        The distally based posterior interosseous island flap for the coverage of skin loss of the hand.
        Ann Plast Surg. 1991; 27: 527-536
        • Tiengo C
        • Dalla Venezia E
        • Lombardi M
        • Bassetto F
        Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources.
        Plast Reconstr Surg Glob Open. 2016; 4 (Published 2016 Jul 11): e794
        • Zaidenberg EE
        • Farias-Cisneros E
        • Pastrana MJ
        • Zaidenberg CR.
        Extended Posterior Interosseous Artery Flap: Anatomical and Clinical Study.
        J Hand Surg Am. 2017; 42: 182-189
        • Ding YC
        • Sun GC
        • Lu Y
        • Ly SY
        The vascular microanatomy of skin territory of posterior forearm and its clinical application.
        Ann Plast Surg. 1989; 22: 126e134
        • Costa H
        • Smith R
        • McGrouther DA.
        Thumb reconstruction by the posterior interosseous osteocutaneous flap.
        Br J Plast Surg. 1988; 41: 228-233
        • Costa H
        • Comba S
        • Martins A
        • Rodrigues J
        • Reis J
        • Amarante J.
        Further experience with the posterior interosseous flap.
        Br J Plast Surg. 1991; 44: 449-455
        • Jakubietz RG
        • Bernuth S
        • Schmidt K
        • Meffert RH
        • Jakubietz MG.
        The Fascia-Only Reverse Posterior Interosseous Artery Flap.
        J Hand Surg Am. Mar 2019; 44 (249.e1-249.e5)
        • Brunelli F
        • Valenti P
        • Dumontier C
        • Panciera P
        • Gilbert A.
        The posterior interosseous reverse flap: experience with 113 flaps.
        Ann Plast Surg. Jul 2001; 47: 25-30
        • Sönmez E
        • Aksam E
        • Durgun M
        • Karaaslan O.
        Venous super-drained posterior interosseous artery flap for dorsal hand defects.
        Microsurgery. 2018; 38: 876-881
        • Bertelli JA
        • Kaleli T.
        Retrograde-flow neurocutaneous island flaps in the forearm: anatomic basis and clinical results.
        Plast Reconstr Surg. 1995; 95: 851e859
        • Puri V
        • Mahendru S
        • Rana R
        Posterior interosseous artery flap, fasciosubcutaneous pedicle technique: a study of 25 cases.
        J Plast Reconstr Aesthet Surg. 2007; 60: 1331-1337
        • Fujiwara M
        • Kawakatsu M
        • Yoshida Y
        • Sumiya A.
        Modified posterior interosseous flap in hand reconstructionTech Hand Up.
        Extrem Surg. Sep 2003; 7: 102-109
        • Neuwirth M
        • Hubmer M
        • Koch H.
        The posterior interosseous artery flap: clinical results with special emphasis on donor site morbidity.
        J Plast Reconstr Aesthet Surg. 2013; 66: 623-628
        • Akin S
        • Ozgenel Y
        • Ozcan M.
        Osteocutaneous posterior interosseous flap for reconstruction of the metacarpal bone and soft-tissue defects in the hand.
        Plast Reconstr Surg. 2002; 109: 982-987
        • Brunelli F
        • Giele H
        • Perrotta R.
        Reverse posterior interosseous flap based on an exteriorized pedicle to cover digital skin defects.
        J Hand Surg Br. 2000; 25: 296-299
        • Costa H
        • Gracia ML
        • Vranchx J
        • Cunha C
        • Conde A
        • Soutar D.
        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
        • Kim KS.
        Distally based dorsal forearm fasciosubcutaneous flap.
        Plast Reconstr Surg. 2004; 114: 389-399
        • Franchi A
        • Häfeli M
        • Scaglioni MF
        • Elliot D
        • Giesen T.
        The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand.
        Microsurgery. Jul 2019; 39: 416-422
        • Chen HC
        • Cheng MH
        • Schneeberger AG
        • Cheng TJ
        • Wei FC
        • Tang YB.
        Posterior interosseous flap and its variations for coverage of hand wounds.
        J Trauma. 1998; 45: 570-574
        • Chang SM.
        Role of large superficial veins in distally based flaps of the extremities.
        Plast Reconstr Surg. 2000; 106: 230e234
        • Imanishi N
        • Nakajima H
        • Fukuzuni S
        • Aiso S.
        Venous drainage of the distally based lesser saphenous-sural veno-neuroadipofascial pedicled fasciocutaneous flap: a radiographic perfusion study.
        Plast Reconstr Surg. 1999; 103: 494e497
        • Gavaskar AS.
        Posterior interosseous artery flap for resurfacing posttraumatic soft tissue defects of the hand.
        Hand (N Y). 2010; 5: 397-402
        • Ege A
        • Tuncay I
        • Erçetin O.
        Posterior interosseous artery flap in traumatic hand injuries.
        Arch Orthop Trauma Surg. 2003; 123: 323-326
        • Kai S
        • Zhao J
        • Jin Z
        • et al.
        Release of severe post-burn contracture of the first web space using the reverse posterior interosseous flap: Our experience with 12 cases.
        Burns. 2013; 39: 1285-1289
        • Lu LJ
        • Gong X
        • Liu ZG
        • Zhang ZX.
        Antebrachial reverse island flap with pedicle of posterior interosseous artery: a report of 90 cases.
        Br J Plast Surg. 2004; 57: 645-652
        • Zhang Y
        • Lu L
        • Lu N
        • Yang Y
        • Gu J
        • Qi F.
        Perioperative Glucocorticoid Treatment of Soft Tissue Reconstruction in Patients on Long-term Steroid Therapy: The Experience of 6 Cases Using Reversed Posterior Interosseous Flap for Hand Neoplasm Surgery.
        Ann Plast Surg. 2018; 81: 302-304
        • Wang JQ
        • Cai QQ
        • Yao WT
        • Gao ST
        • Wang X
        • Zhang P.
        Reverse posterior interosseous artery flap for reconstruction of the wrist and hand after sarcoma resection.
        Orthop Surg. 2013; 5: 250-254