The reverse posterior interosseous artery flap: Technical considerations in raising an easier and more reliable flap

Acharya, AM and Bhat, Anil K and Kumar, Bhaskaranand (2012) The reverse posterior interosseous artery flap: Technical considerations in raising an easier and more reliable flap. Journal of Hand Surgery, 37A (3). pp. 575-582.

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Purpose Major injuries of the hand with skin loss often require early flap cover, which should be versatile, simple in technique, and safe. The reverse posterior interosseus flap satisfies all of these requirements. Over the years, refinements in the technique of harvesting this flap have evolved to prevent venous congestion and flap necrosis. This study presents adaptations to avoid such complications and raise a successful flap. Methods A total of 21 patients underwent this flap reconstruction between January 2008 and November 2010 for injuries around the wrist and hand. The average follow-up period was 6 months; 19 were male and 2 were female. The average age was 33 years (range, 9–70 y). In 17 patients, the flap reconstructions were done for posttraumatic injuries, in 2 after skin defects following tumor resection, and 1 each after defects resulting from release of first web contracture in multiple congenital contractures and burns. Average size of the flap was 51 cm2 (range, 90– 30 cm2). The donor area was covered by a split skin graft. Results All flaps survived without major complications. Generally the flap matched the surrounding skin except for palmar defects. No patients reported donor skin graft color mismatch. Conclusions The reverse posterior interosseous flap is a reliable and safe flap for soft tissue cover to the wrist, palm, dorsum of hand, first web space, and metacarpophalangeal joints. Thorough attention to the technical details, including performing a proximo-distal flap dissection with the deep fascia, avoiding dissection of the anastomotic arc between posterior and anterior interosseous artery, creating a broad pedicle with a cutaneous handle, and avoiding its tunneling for inset, will contribute to survival of the flap.

Item Type: Article
Uncontrolled Keywords: Posterior interosseous artery; pedicled flap; dorsal hand defects; thumb webspace.
Subjects: Medicine > KMC Manipal > Orthopaedics
Depositing User: KMC Manipal
Date Deposited: 22 Sep 2014 04:34
Last Modified: 22 Sep 2014 04:34

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