Technical tips in reverse flow posterior interosseous artery flaps

Objective: For avoiding contracture formation, coverage of exposed tendons, bones, nerves, joints or vascular structures, flaps are preferred over other soft tissue reconstruction techniques used in hand. Reverse flow posterior interosseous flaps as an option in hand reconstruction and the ways to obtain higher survival rates based on our experience is described and discussed in this article. Materials and Methods: From July 2003 to June 2013, 45 patients aged between 7 and 69 years (mean 34.6 years) were operated for soft tissue reconstruction of hand using distally based posterior interosseous flap. Results: Operative plan was changed ın one out of 45 flaps due to small pedicle calibre. Only one of the flaps was totally necrosed. No partial necrosis was seen. Conclusion: Reliability of posterior interosseous flaps are sometimes unpredictable due to the anatomical variability of posterior interosseous artery. We do not attempt to make pedicle dissection more proximal to the midpoint of dorsal axis line. Extension of the distal part of reverse flow posterior interosseous flap into the distal third territory is strongly recommended in every case, especially for more distant defects. By doing so, we include a piece of skin with numerious septocutaneous perforators arriving from posterior interosseous artery and their accompanying veins in the distal third region, thus obtaining higher survival rates.
We believe that reverse flow posterior interosseous flaps are reliable in reconstruction of hand defects and the application of those operative techniques used in this study improve flap survival rates.