Distally Based Posterior Interosseous Flap

Ağır, Hakan; Şen, Cenk Ahmet; Alagöz, Şahin; Onyedi, Murat; Işıl, Eda

doi:10.1097/sap.0b013e31802f8408

Cited by 21 publications

(22 citation statements)

References 18 publications

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“…The reconstruction of lost soft tissues in the distal segment of the forearm, wrist, and hand is a challenge (1) . Tissue lesions in these regions are caused mainly by trauma, possibly leading to exposed bone, tendon, nerve and/or blood vessels 1 , 2 . Such lesions may require local, regional, or microsurgical flaps to cover these defects, in order to minimize infection, provide protection, and facilitate future reconstructions 1 , 2 , 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Tissue lesions in these regions are caused mainly by trauma, possibly leading to exposed bone, tendon, nerve and/or blood vessels 1 , 2 . Such lesions may require local, regional, or microsurgical flaps to cover these defects, in order to minimize infection, provide protection, and facilitate future reconstructions 1 , 2 , 3 . Soft tissue reconstruction in these regions should be fast, preferably in a single procedure, allowing for early mobility and a short hospital stay, in order to achieve satisfactory functional and aesthetic results 1 , 2 , 3 .…”

Section: Introductionmentioning

confidence: 99%

“…Local flaps (Atasoy, Kuttler, Litter, Morberg) are used for small amounts of tissue loss and with specific indications 1 , 2 , 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Free flaps obtained from other regions have drawbacks such as a long operating time, technical difficulties, and the need for microsurgical expertise and materials 1 , 2 , 6 .…”

Section: Introductionmentioning

confidence: 99%

“…However, these are flaps that sacrifice the main arteries supplying the hand, besides resulting in severe damage to donor sites 1 , 3 , 7 . The dorsal ulnar flap has a short pedicle with limited rotation and is indicated in dorsal ulnar and proximal palmar defects 2 , 3 , 7 . The flap of the anterior interosseous artery has a weak pedicle and variable anatomy 3 , 7 .…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Posterior Interbone Artery Flap for Covering Serious Forearm, Wrist and Hand Injuries

Lima

Costa

Oliveira

et al. 2009

Revista Brasileira de Ortopedia (English Edition)

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To assess the results achieved with posterior interbone artery flap covering serious injuries of the distal third of the forearm, wrist and hand, evaluating the degree of effectiveness of this procedure. Methods: 35 patients with serious injuries of the distal third of upper limbs were studied. We assessed the kind of trauma, injury site, flap size, skin coverage need, clinical outcome and complications. Results: The most frequent mechanism of trauma was motorcycle accident. The most commonly affected regions were: dorsal hand, wrist volar regions and the first commissure. In all patients, the flap size was enough to cover key tissues exposed by the injury. The donor area did not show complications, being primarily closed in 23 cases. The outcomes were good for 31 cases. In 22 patients, no complication was found, and the flap was completely lost in four. Conclusion: Posterior interbone artery flap provides good outcomes in covering serious injuries of the distal third of upper limbs, leading to a stable and reliable coverage, not compromising key irrigating arteries of the hand, enabling the performance of reconstruction procedures. Therefore, this is a useful alternative in such cases.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Local flaps (Atasoy, Kuttler, Litter, Morberg) are used for small amounts of tissue loss and with specific indications 1 , 2 , 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Free flaps obtained from other regions have drawbacks such as a long operating time, technical difficulties, and the need for microsurgical expertise and materials 1 , 2 , 6 .…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Posterior Interbone Artery Flap for Covering Serious Forearm, Wrist and Hand Injuries

Lima

Costa

Oliveira

et al. 2009

Revista Brasileira de Ortopedia (English Edition)

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The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand

et al. 2019

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Introduction There is growing evidence of the superior ability of muscular tissue to clear bacterial bone infection. Unfortunately, in the hand, there are almost no small local muscular flaps, and muscular transfers to the hand are mainly microsurgical free transfers. In this report, we present the results of the use of a chimeric posterior interosseous flap including part(s) of the forearm muscles to treat osteomyelitis and soft tissue defect of hand from a series of patients. Patients and Methods Four male patients with an average age of 32 years (range 20–46 years), were affected by acute osteomyelitis in hand. Previous fracture fixation with percutaneous K‐wires was the cause of bone infection in three case. In one case, the osteomyelitis was a consequence of an open fracture. The bones affected were four metacarpals and one proximal phalanx, all with a minimal cortical defect (from the K‐wire) obscuring a larger medullary infection, which required extensive bone and overlying soft tissue debridement, leaving a soft tissue defect to be reconstructed of size ranging from 2 x 4 cm to 5 x 7 cm. The soft tissue defects were due to concomitant superficial infection and consequent debridement. All patients were treated with bone debridement and a chimeric posterior interosseous flap, which included part of the extensor digiti minimi and/or extensor carpi ulnaris to fill the intramedullary canal of the bones. No fixation of bone was necessary. Results The skin paddle of the flaps ranged from 2 x 5 cm to 5 x 6 cm, replicating the defect area, plus a teardrop tail of skin circa 1.5 cm wide and as long as the pedicle of the flap. The muscular components of the flaps used to fill the intramedullary canals ranged from 1 x 1 x 1.5 cm to 1.5 x 1.5 x 4 cm. All flaps survived and osteomyelitis resolved in all cases without major complications. At the final follow‐up at 16 months (range 12–26 months), assessment of the hands using TAM, Power Grip and Key Pinch Strength measurements and, where appropriate, Kapandji scores, demonstrated satisfactory hand function. Conclusion The chimeric posterior interosseous flap including part of the muscles of the forearm may be a robust solution for augmenting the flap bulk and may be used in cases of severe osteomyelitis of the hand.

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An extended distally based reverse posterior interosseous artery flap reconstruction for the thumb and distal defects of the fingers

et al. 2021

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Background The reverse posterior interosseous artery flap is useful for covering hand defects. However, its major drawback is the short pedicle that limits the reach of the flap up to the metacarpophalangeal level. The authors performed a new modification extending the distal reach of the flap by including the recurrent branch of the posterior interosseous artery and they aimed to present the results of reconstruction with this technique. Patients and methods Seven patients with a mean age of 35.2 years (range 17–64 years) underwent extended RPIAF surgery. Six patients were admitted to the emergency department with isolated hand trauma. One patient was present in elective settings with chronic osteomyelitis and skin loss of the thumb related to previous trauma. The defects were located on the distal metacarpophalangeal level (thumb and other fingers). PIA perforators and the recurrent branch were included into the pedicle (Type A) in five cases, whereas the flap was harvested based solely on the recurrent branch (Type B) in two cases. The type B flaps had longer pedicle lengths due to discarding the forearm skin. The donor sites were covered with skin grafts in six patients. Results The average size of the extended RPIAF was 3 × 3.5 cm to 10 × 6 cm (mean 8.28 × 4.14 cm). All of the flaps completely survived, and no complications were encountered during the postoperative period. Functional recovery of the operated hands were observed during the follow up period 13.5 months (8–24 months). Both the patient and our satisfactory levels were high and all of the patients returned to their works. Quick DASH score was used in the final functional evaluation retrospectively. Due to the pandemic, the evaluation could be made with a telephone. Two patients could not be reached in the evaluation. The mean quick DASH score of five patients was 28.64. Conclusion The extended RPIAF is a reliable choice in distally located thumb and finger defects if the recurrent branch of the posterior interosseous artery is included in the pedicle.

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Distally Based Posterior Interosseous Flap

Cited by 21 publications

References 18 publications

Posterior Interbone Artery Flap for Covering Serious Forearm, Wrist and Hand Injuries

Posterior Interbone Artery Flap for Covering Serious Forearm, Wrist and Hand Injuries

The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand

An extended distally based reverse posterior interosseous artery flap reconstruction for the thumb and distal defects of the fingers

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