Reverse-Flow Posterior Interosseous Flap—A Review of 68 Cases

We are reporting our 10-year experience with 68 patients. Sixty-six flaps were of fasciocutaneous type and two were of osteofasciocutaneous type. These flaps were used for volar and dorsal traumatic hand defects, first web space reconstruction, thumb reconstruction, and repair of congenital anomalies. Sixty flaps (88.24%) had complete uneventful take-up. Four flaps developed partial necrosis, whereas four flaps suffered complete necrosis. The single most important factor for flap survival in our experience has been inclusion of at least two perforators to supply the skin pedal. The proximal flap dissection has a learning curve and all of our poor results were in the early part of our experience. We believe that posterior interosseous fasciocutaneous flap (PIF) is a versatile and reliable option for the challenging problems of hand soft-tissue coverage.

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Versatility of the Posterior Interosseous Artery Flap: Emphasis on Powering Up the Toe Transfer

Hand ◽

10.1177/15589447211028925 ◽

2021 ◽

pp. 155894472110289

Author(s):

GiJun Lee ◽

BumSik Kim ◽

Neunghan Jeon ◽

JungSoo Yoon ◽

Ki Yong Hong ◽

...

Keyword(s):

Soft Tissue ◽

Upper Extremity ◽

Reverse Flow ◽

Donor Site ◽

Congenital Defects ◽

Soft Tissue Coverage ◽

Posterior Interosseous Artery ◽

Arterial Inflow ◽

Pedicle Length ◽

Interosseous Artery

Background: Reverse-flow posterior interosseous artery (rPIA) flap is an excellent tool for restoration of defects in the hand and upper extremity, sparing the main arteries to the hand. Its reliability has been well established. Materials and Methods: Fifty-one cases of rPIA flap involving 49 patients were retrospectively reviewed. The inclusion criteria were age, sex, etiology, size and location of the defect, flap size, number of perforators included, pedicle length, flap inset, donor site coverage, complications, and ancillary procedures. Results: This study included 44 men and 5 women, ranging in age between 10 and 73 years. The subjects had soft tissue defects of the hand and upper extremity mainly due to traumatic injuries, including scar contractures of the first web space in 18 cases, thumb amputations in 6 cases, and congenital defects in 1 case. Among the 51 rPIA flap elevations, 3 cases involved flap failure due to the absence of proper pedicle. A fasciocutaneous pattern was observed in 45 cases and a myocutaneous pattern in 3 cases. In 5 cases of unplantable thumb amputations, the rPIA flap was performed for arterial inflow to the secondary toe-to-thumb transfer. Venous congestion of varying degrees was noted in 7 cases involving partial necrosis in 2 cases. During the mean 17 months of follow-up, patients were generally satisfied with the final outcomes. Conclusion: The rPIA flap can be used not only for soft tissue coverage of the hand and upper extremity but also as a recipient arterial pedicle for a secondary toe-to thumb transfer.

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POSTERIOR INTEROSSEOUS ARTERY FLAP: OUR EXPERIENCE AND REVIEW OF MODIFICATIONS DONE

Hand Surgery ◽

10.1142/s0218810414500178 ◽

2014 ◽

Vol 19 (02) ◽

pp. 181-187 ◽

Cited By ~ 5

Author(s):

Poh Ling Fong ◽

Winston Yoon Chong Chew

Keyword(s):

Thumb Reconstruction ◽

Flap Survival ◽

Posterior Interosseous Artery ◽

Hand Defects ◽

Interosseous Artery ◽

Posterior Interosseous Artery Flap

This is a report on the 14 PIA flaps done in our centre for traumatic hand defects over both volar and dorsal aspects, as well as thumb reconstruction over a six-year period from 2000 to 2007. We were able to achieve reach to the DIPJ with the use of fascia extension and better flap survival with more perforators captured in the flap.

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Transplantation of an Osteoarthrotendinous Allograft with Autogenous Soft-Tissue Coverage for Thumb Reconstruction

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199110000-00026 ◽

1991 ◽

Vol 88 (4) ◽

pp. 713-717 ◽

Cited By ~ 7

Author(s):

James Robert Wendt

Keyword(s):

Soft Tissue ◽

Soft Tissue Coverage ◽

Thumb Reconstruction

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Distally based peroneal artery perforator-plus fasciocutaneous flap in the reconstruction of soft tissue defects over the distal forefoot: a retrospectively analyzed clinical trial

10.21203/rs.3.rs-43530/v1 ◽

2020 ◽

Author(s):

Ping Peng ◽

Zhaobiao Luo ◽

Guohua Lv ◽

Jiangdong Ni ◽

Jianwei Wei ◽

...

Keyword(s):

Soft Tissue ◽

Kirschner Wire ◽

Fasciocutaneous Flap ◽

Peroneal Artery ◽

Soft Tissue Defects ◽

Patient Factors ◽

Partial Necrosis ◽

Distally Based ◽

Artery Perforator ◽

Tissue Defects

Abstract Background: Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps are widely used for reconstructing soft-tissue defects of the lower extremity. However, large studies on this topic, especially DPAPF flaps use for reconstruction of defects over the distal forefoot, are scarce. Herein, we describe our experience on the reconstruction of defects over the distal forefoot using DPAPF flaps.Methods: Between February 2005 and August 2019, 56 DPAPF flaps were used to reconstruct soft-tissue defects in the forefoot. The ankles were fixed in dorsiflexion using a Kirschner wire. Patient factors and flap factors were compared between the “survival” and “partial necrosis” groups.Results: Overall, 47 flaps had survived completely in one stage. Partial necrosis developed in nine flaps, with only one remnant defect covered using a local flap. The distance between the pivot point and recipient area was reduced by fixing the ankles in dorsiflexion. The partial necrosis rate of the DPAPF flaps with the top edge located in the 8th zone was significantly lower than that in the 9th zone (p < 0.05).Conclusions: In combination with fixing of the ankles in dorsiflexion using a Kirschner wire, DPAPF flap is a good option in reconstructing a defect over the distal forefoot.

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Venous Flaps for Revascularization and Soft-Tissue Coverage in Traumatic Hand Injuries: A Systematic Review of the Literature

Journal of Reconstructive Microsurgery ◽

10.1055/s-0039-1695053 ◽

2019 ◽

Vol 36 (02) ◽

pp. 104-109

Author(s):

John M. Roberts ◽

Logan W. Carr ◽

Christopher T. Haley ◽

Randy M. Hauck ◽

Brett F. Michelotti

Keyword(s):

Systematic Review ◽

Soft Tissue ◽

Hand Injuries ◽

Cochrane Library ◽

Soft Tissue Coverage ◽

Review Of The Literature ◽

Flap Survival ◽

Venous Flaps ◽

Arterial Inflow ◽

Venous Flap

Background The use of the venous flap for simultaneous revascularization and coverage of soft tissue defects has been documented in the literature for over 30 years. First described in 1981, Nakayama et al demonstrated that a vein and overlying skin, or a venous flap, may be transposed from one area of the body to another with complete survival of the graft. The aim of this study was to conduct a systematic review of the literature to determine predictors of venous flap survival in traumatic hand injuries. Methods A literature search of PubMed, MEDLINE, and Cochrane Library was performed with emphasis on venous flap use in traumatic hand injuries. MeSH terms included: vein graft, revascularization, venous flow through flap, arterialized venous flap, bypass, replantation, amputation, avulsion, trauma, injury, amputate, finger, hand, and thumb. Results Forty-three articles were collected that contained data on 626 free venous flaps. Most patients were males (73.9) and injured their right hand (52.3%). The forearm was the most commonly used venous flap donor site (83.6%), and most of the skin paddles were 10 to 25 cm2 (41.1%). Arterial inflow was used in 93.1% of the flaps. Most venous flaps (79.6%) healed without superficial tissue loss or necrosis. Ninety-two (14.7%) flaps had partial loss while 36 (5.8%) flaps did not survive. Conclusion The use of venous flaps for concomitant revascularization and soft tissue coverage of the hand permits good results with limited morbidity. The overall flap survival rate is nearly 95%. Younger patients whose flaps have arterial inflow and skin paddles of medium size (10–25 cm2) have the best chance for survival.

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Reconstruction of Hind and Mid-Foot Defects after Melanoma Resection Using the Reverse Sural Flap: A Case Series

The Surgery Journal ◽

10.1055/s-0037-1604473 ◽

2017 ◽

Vol 03 (03) ◽

pp. e124-e127 ◽

Cited By ~ 2

Author(s):

Juan Larrañaga ◽

Pedro Picco ◽

Alejandro Yanzon ◽

Marcelo Figari

Keyword(s):

Soft Tissues ◽

Reverse Flow ◽

Weight Bearing ◽

Case Series ◽

Viable Option ◽

Sural Flap ◽

Flap Survival ◽

Partial Necrosis ◽

The Mean ◽

Sural Artery

Background Melanoma resection creates important soft tissues defects, which are difficult to manage when located on the weight-bearing heel and mid foot. There is little evidence on the use of the reverse-flow sural flap for this type of reconstruction. Objective This study reports our case series on the reconstructive management of the hind and mid-foot defects after melanoma resection using the reverse sural artery flap. Materials and Methods This is a retrospective study of four consecutive patients treated with resection of melanoma of the feet and reconstruction with reverse sural artery flap from 2006 to 2009. Results The mean age of the patients was 54 years, three were females, and one was male. Three of the defects were located on the weight-bearing heel, the other on the mid-foot dorsum. The melanomas were fully resected with wide margins. Three patients were reconstructed primarily, whereas one patient was reconstructed 4 weeks after the resective surgery. This series revealed 100% flap survival and there was no partial necrosis. Major complications were not observed. The four patients completely recovered the function of the affected limb. Conclusion The reverse sural flap is a viable option for the reconstruction of foot defects after melanoma resection.

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Soft tissue coverage and thumb reconstruction

Essentials of Hand Surgery ◽

10.5005/jp/books/12510_18 ◽

2015 ◽

pp. 185-185

Author(s):

Kevin Chung ◽

Keming Wang ◽

Evan Kowalski

Keyword(s):

Soft Tissue ◽

Soft Tissue Coverage ◽

Thumb Reconstruction

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REVERSE FLOW SURAL FLAP;

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.01.2582 ◽

2019 ◽

Vol 26 (01) ◽

Author(s):

Hyder Ali ◽

Faraz Adil ◽

Farah Idress

Keyword(s):

Soft Tissue ◽

Reverse Flow ◽

Donor Site ◽

Donor Site Morbidity ◽

Soft Tissue Coverage ◽

Sural Flap ◽

Venous Ulcers ◽

Flap Failure ◽

Dorsum Of Foot ◽

Sural Artery

Background:Soft tissues injuries at foot especially at heel expose the tendons, bones and especially joints, which leads to risk of infections and necrosis. These often result from trauma (spoke wheel), tumors, systemic diseases and their wounds such as venous ulcers and diabetic foot wounds. Surgical planning of these defects remains a challenge due to shortage of local scar free tissue and reliable blood supply. The current study is conducted to observe the purposeful benefits of reverse sural artery flap to cover wounds at dorsum of foot, ankle & heel.Study Design:Descriptive, experimental study.Setting: Department of Plastic & Reconstructive Surgery, Dr. Ruth KM Pfau Civil Hospital Karachi.Period:January 2015 to January 2018.Material & Methods:All patients who presented with wounds at heel, dorsum of foot, and exposed calcaneus or Achilles tendon were included. A peroneal based perforator identified by hand held Doppler, a superficial vein, and the sural nerve were included in the pedicle. Patients were followed during the first 6 postoperative months. Postoperative outcomes like flap congestion, tip necrosis and flap failure were noted. Results:Total of 36reverse low sural flaps were done for the soft tissue coverage of the 24 heel defects, 8 ankle defects and4 dorsum of the foot defects. Twenty eight patients were male and eight were females and age ranged from 6 to 36 years (mean 21). Partial flap failure was seen in 3 cases and complete flap failure in 2 cases. There were no serious donor site complications and all patients were satisfied with the functional and aesthetic outcome postoperatively.Conclusion:Reverse sural artery flap is very suitable in providing soft tissue coverage of the wounds of heel and dorsum of foot. Harvesting sural flap is dependable and safe as it does not ends in any major postoperative donor site morbidity.

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