Hand and wrist reconstruction with a posterior interosseus artery flap: case report and literature review
DOI:
https://doi.org/10.18203/2349-2902.isj20262334Keywords:
Posterior interosseus artery, Posterior interosseus artery flap- hand reconstruction, Dorsal hand defects, Upper limb reconstructionAbstract
The posterior interosseous artery flap (PIAF) is an invaluable tool in reconstructive hand surgery, providing a versatile and reliable option for soft tissue defects while maintaining the major vascular axes of the upper limb. We provide a comprehensive review of the PIAF, describe the relevant vascular anatomy, including the origin and course of the posterior interosseous artery (PIOA), and discuss the many advantages of this flap, such as excellent tissue match and the avoidance of major artery sacrifice. Also, discussed are the surgical technique and possible complications, particularly venous congestion, and their management. Finally, we address the disadvantages of the procedure, including the challenging dissection near the posterior interosseous nerve and the limitations in flap width, to provide a balanced perspective for the reconstructive surgeon.
References
Acharya AM, Bhat AK, Bhaskaranand K. The reverse posterior interosseous artery flap: technical considerations in raising an easier and more reliable flap. J Hand Surg. 2012;37(3):575-82.
Adidharma W, Chung KC. Recent advances in upper extremity microsurgery: From traditional to perforator flaps. Hand Clin. 2024;40(2):161-6.
Akinci M, Ay S, Kamiloglu S, Erçetin O. The reverse posterior interosseous flap: A solution for flap necrosis based on a review of 87 cases. J Plastic Reconstruct Aesthet Surg. 2006;59(2):148-52.
Angrigiani C, Grilli D, Dominikow D, Zancolli EA. Posterior interosseous reverse forearm flap: experience with 80 consecutive cases: Experience with 80 consecutive cases. Plastic Reconstruct Sur. 1993;92(2):285-93.
Bayon P, Pho RW. Anatomical basis of dorsal forearm flap. Based on posterior interosseous vessels: Based on posterior interosseous vessels. J Hand Surg Edinburgh, Scotland). 1988;13(4):435-9.
Franchi A, Häfeli M, Scaglioni MF, Elliot D, Giesen T. The use of chimeric musculocutaneous posterior interosseous artery flaps for treatment of osteomyelitis and soft tissue defect in hand. Microsurgery. 2019;39(5):416-22.
Hamdi M, Van Landuyt K, Monstrey S, Blondeel P. A clinical experience with perforator flaps in the coverage of extensive defects of the upper extremity. Plastic Reconstructive Surg. 2004;113(4):1175-83.
Mei J, Morris SF, Ji W, Li H, Zhou R, Tang M. An anatomic study of the dorsal forearm perforator flaps. Surgical and Radiologic Anatomy. 2013;35(8):695-700.
Page R, Chang J. Reconstruction of hand soft-tissue defects: alternatives to the radial forearm fasciocutaneous flap. J Hand Surg Am. 2006;31(5):847-56.
Panse N, Sahasrabudhe P. Free style perforator based propeller flaps: Simple solutions for upper extremity reconstruction! Indian J Plastic Surg. 2014;47(1):77-84.
Sönmez E, Aksam E, Durgun M, Karaaslan O. Venous super-drained posterior interosseous artery flap for dorsal hand defects. Microsurgery. 2018;38(8):876-81.
Sun C, Wang YL, Ding ZH, Liu P, Qin XZ, Lee HL. Anatomical basis of a proximal fasciocutaneous extension of the distal-based posterior interosseous flap that allows exclusion of the proximal posterior interosseous artery. J Plast Reconstr Aesthet Surg. 2015;68(1):17-25.
Vitse J, Bekara F, Bertheuil N, Sinna R, Chaput B, Herlin C. Perforator-based propeller flaps reliability in upper extremity soft tissue reconstruction: a systematic review. J Hand Surg Eur Volume. 2017;42(2):157-64.
Zaidenberg EE, Farias-Cisneros E, Pastrana MJ, Zaidenberg CR. Extended posterior interosseous artery flap: Anatomical and clinical study. J Hand Surg. 2017;42(3):182-9.