Versatile Use Of 'The Posterior Interosseous Flap' In The Reconstruction Of Complex Upper Limb Defects

Abstract

BACKGROUND: Reconstruction of the complex upper extremity defects is a challenging procedure for reconstructive surgeons because of the complex anatomical and functional structure of this region. In reconstruction, local and regional flap options involving the composite tissues are restricted. The posterior interosseous flap (PIO) has been presented "in a single study" with a wide variety of uses, and in this study, the versatility of PIO has been tried to be emphasized by its multitude uses as well as its chance at adaptability to each case. Hence, due to this, the objective to highlight the versatile utility of the PIO flap in clinical practice and to present a good option for the reconstruction of complex upper limb defects for various cases have been targeted. METHODS: We used 26 PIO flaps in 25 patients (18 male and seven female patients) with upper limb defects. The main etiological causes were burn contracture, traffic accident, firearm and acute burn injury. Twenty-two flaps were harvested as fasciocutaneous and four flaps as osteo-fasciocutaneous manner, which were applied to the metacarpal defects. In this study, 25 flaps were transferred as pedicled flaps, of which 23 and 2 flaps had reverse and antegrade blood flows, respectively, whereas one flap was used as a free flap. RESULTS: The mean follow-up period was 14 months. All flaps except one, which had partial necrosis and secondary healed, survived completely. All patients were able to gain basic functions for daily routine activities in the late postoperative period. Patients and/ or their parents were satisfied with the postoperative functional and aesthetic improvements. CONCLUSION: Many advantages of the PIO flap make it useful for the reconstruction of upper limb complex defects. It can be versatilely used based on changing its flow direction and enrichment of contents.

A strong reconstruction option for tissue loss on hand and wrist due to firearm injury in the Syrian war

“…[ 4 , 15 ] As the posterior interosseous flap allows splint applications in postoperative fracture reduction, it is considered to be a better and useful flap method. [ 16 , 17 ] As a result of the present study, it strongly supports the thesis that PIF is the best option in these injured cases.…”

“…In war-related gunshot injuries, flap options cannot be preferred unless the patient is obliged due to the difficulties in the reduction and healing of hand and wrist fractures, due to multiple traumas in the patient [4,15] . As the posterior interosseous flap allows splint applications in postoperative fracture reduction, it is considered to be a better and useful flap method [16,17] . As a result of the present study, it strongly supports the thesis that PIF is the best option in these injured cases.…”

“…[ 20 ] In this sense, PIF has aroused increasing interest in plastic hand surgeons and is one of the most frequently used skin flaps in reconstructive surgery. [ 11 , 16 , 17 ] Although it has support from the anterior interosseous artery, it has low arterial pressure. [ 21 ] As the distal third of the flap or, in other words, the proximal third of the forearm, the blood flow is weak, it carries a risk of necrosis.…”

“…Distal-based fasciocutaneous flaps on the forearm have proven to be simple use, versatile and reliable flaps; they can be used to reconstruct a wide variety of soft tissue defects of the hand [20] . In this sense, PIF has aroused increasing interest in plastic hand surgeons and is one of the most frequently used skin flaps in reconstructive surgery [11,16,17] . Although it has support from the anterior interosseous artery, it has low arterial pressure [21] .…”