The authors present a study of the surgical anatomy of the posterior interosseous artery (PIA) in 70 cases to establish the anatomic basis of a new forearm fascio-cutaneous flap, the posterior interosseous flap which has been described by one of the authors (AC Masquelet). The PIA was verified in every case. Its course corresponds to a line drawn from the lateral epicondyle of the humerus to the head of the ulna, i.e. to the septum between the extensor carpi ulnaris and extensor digiti minimi proprius muscles. The artery, whose average caliber is 1.7 mm, gives off 7 to 14 cutaneous branches in its course. The point of emergence of the artery in the posterior aspect of the forearm corresponds to the junction between the upper and middle thirds of the line from the epicondyle and the ulnar head. The PIA anastomoses with the anterior interosseous artery and the dorsal carpal network in 98.6% of cases. The artery remains closely related to the deep branch of the radial nerve and is crossed by the branches of this nerve to the extensor carpi ulnaris muscle. The cutaneous distribution of the PIA extends from elbow to wrist, centered on the epicondylarulnar line, with an average breadth of 5 cm. Twelve operations have already been performed using the posterior interosseous flap, 2 with a direct pedicle and 10 with a retrograde pedicle, and all survived completely.

An anatomical study made in 25 injected fresh subjects made it possible to map out the periosteal flaps capable of being raised on the limbs. The preferred donor sites are the distal third of the humerus, the iliac fossa and the distal third of the femur. At the last 2 sites composite osteo-periosteal or musculo-osteo-periosteal flaps can be raised. These technical possibilities illustrate the importance of experimental studies which have shown the osteogenic capacity of grafts of vascularized periosteum.

No abstract

The osteogenic capacity of vascularized periosteal and osteoperiosteal grafts was investigated in 82 Wistar rats about 8 weeks old. The periosteal flaps, pedicled on the descending genicular artery, were taken by stripping the lower third of the femur. In the right hindleg, the grafts were made with periosteum only, while in the left hindleg, the periosteal flaps were associated with cancellous bone. The animals were divided into two groups of 41. In group I, both the periosteal and osteoperiosteal grafts were placed in contact with cortical bone, and in group II, the grafts were buried in muscle. Subgroups of 8 animals were killed after 1, 2, 4, 8, and 16 weeks postoperatively. The grafted region was evaluated radiographically, macroscopically, and histologically. Membranous ossification was the main source of bone formation. Osteoperiosteal grafts produced a greater amount of new bone than periosteal ones. There was evidence that the contact of the graft with living cortical bone favored bone formation.

No abstract