Antegrade Posterior Interosseous Flap for Nonhealing Wounds of the Elbow: Anatomical and Clinical Study

Abstract

Background:The posterior interosseous artery (PIA) flap has been widely reported to cover defects at the dorsal aspect of the hand. However, the use of this flap to cover elbow defects has been rarely reported. The purpose of this study was to analyze the anatomical feasibility of the PIA flap to cover elbow soft-tissue defects and, additionally, to review the clinical outcomes of patients treated with this flap.Methods:An anatomical study was performed on 14 cadaveric specimens to assess the number of PIA perforators at the distal third of the forearm, along with the distance of the perforators from the ulnar styloid. Additionally, the pedicle distance from the pivot point to the lateral epicondyle was recorded. A clinical study in 4 patients with elbow soft-tissue defects treated with the antegrade PIA was also performed to assess viability and clinical outcomes.Results:A mean of 3 perforators (range, 2–4) of the PIA were found in the distal third of the forearm. The pedicle distance from the pivot point to the lateral epicondyle was 10 cm (range, 8–11.5 cm). In the clinical study, all cases treated with the antegrade PIA flap showed satisfactory outcomes without loss of the flap or significant partial necrosis.Conclusion:In this limited series, the antegrade PIA flap has shown to be a reliable and effective alternative for treatment of soft-tissue defects at the elbow. The PIA perforators in the distal forearm and the pedicle length allow the flap to easily reach the elbow.

Use of the Antegrade Posterior Interosseous Artery Flap for Coverage of Complex Elbow Wounds

“…No extensor tendon palsies, which have been reported previously with this technique, and no complications at the donor site were reported in the postoperative period. 9…”

Vascularized ulnar periosteal pedicled flap for forearm nonunion in children

“…Microsurgical techniques for vascularized bone grafts, such as the vascularized fibula bone grafts, are demanding. Local pedicled vascularized flaps offer several advantages over free flaps, including less donor-site morbidity, an operative field limited to one upper extremity; less technically demanding and, therefore, skillsets that are achievable by most hand surgeons (Costa et al., 2001; Jakubietz et al., 2019; Zaidenberg et al., 2018).…”

“…Based on the PIV, the ulnar periosteal pedicle flap has been successfully used in different ways, by altering its flow (anterograde, proximally based or retrograde, distally based) and soft tissue contents (fascia, fascio-cutaneous, osteo-fascio-cutaneous) (Barın et al., 2019; Jakubietz et al., 2019; Tiengo et al., 2016; Zaidenberg et al., 2018). In our cohort, we have found that the flap was versatile to cover small and medium defects in the forearm without any tension in the pedicle.…”

Total Elbow Arthroplasty and Antegrade Posterior Interosseous Flap for Infected Posttraumatic Arthritis with an Active Fistula. A Rationale for Comprehensive Treatment. Case Report

“…4 Therefore, the soft tissue coverage remains a major aspect during the treatment of an infection about the elbow. The posterior interosseous artery (PIA) flap has been described as an alternative option for soft tissue defects smaller than 40cm2, 5 its advantages include that the PIA is very constant, donor site morbidity is scarce and does not require advanced microsurgical technique. Anconeus, brachioradialis, latissimus dorsi, and flexor carpi ulnaris muscle flaps as well as radial forearm and lateral arm fascio-cutaneous flaps are some of the more commonly reported flaps for reconstruction.…”