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

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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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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Microsurgical Reconstruction of the Lower Extremity

Seminars in Plastic Surgery ◽

10.1055/s-0039-1677878 ◽

2019 ◽

Vol 33 (01) ◽

pp. 054-058 ◽

Cited By ~ 3

Author(s):

Luke Grome ◽

William Pederson

Keyword(s):

Soft Tissue ◽

Lower Extremity ◽

Donor Site ◽

Foot Drop ◽

Long Term Results ◽

Anterolateral Thigh Flap ◽

Soft Tissue Coverage ◽

Soft Tissue Reconstruction ◽

Muscle Flaps ◽

Microsurgical Reconstruction

AbstractReconstruction of bony and soft tissue defects of the lower extremity has been revolutionized by the advent of microsurgical tissue transfer. There are numerous options for reconstruction. Possibilities include transfer of soft tissue, composite (bone and soft tissue) tissue, and functional muscle. Many lower extremity reconstructions require staged procedures. Planning is of paramount importance especially in regard to vascular access when multiple free flaps are required. Soft tissue reconstruction of the lower extremity may be accomplished with muscle flaps such as the rectus femoris and latissimus dorsi covered with a skin graft. Fasciocutaneous flaps such as the anterolateral thigh flap may be more appropriate in a staged reconstruction which requires later elevation of the flap. Loss of a significant portion of bone, such as the tibia, can be difficult to manage. Any gap greater than 6 cm is considered a reasonable indication for vascularized bone transfer. The contralateral free fibula is the donor site of choice. Functional reconstruction of the anterior compartment of the leg may be performed with a gracilis muscle transfer, effectively eliminating foot drop and providing soft tissue coverage. Muscle tensioning is critical for effective excursion and dorsiflexion of the foot. Long-term results of microsurgical reconstruction of the lower extremity show good results and reasonable rates of limb salvage.

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Functional Soft-Tissue Coverage in Skeletonizing Injuries of the Upper Extremity Using the Ipsilateral Latissimus Dorsi Myocutaneous Flap

Plastic & Reconstructive Surgery ◽

10.1097/00006534-199510000-00021 ◽

1995 ◽

Vol 96 (5) ◽

pp. 1130-1135 ◽

Cited By ~ 14

Author(s):

Günter Germann ◽

Hans-Ulrich Steinau

Keyword(s):

Soft Tissue ◽

Upper Extremity ◽

Latissimus Dorsi ◽

Myocutaneous Flap ◽

Soft Tissue Coverage ◽

Latissimus Dorsi Myocutaneous Flap

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

Hand ◽

10.1007/s11552-007-9031-9 ◽

2007 ◽

Vol 2 (3) ◽

pp. 112-116 ◽

Cited By ~ 10

Author(s):

Tahseen A. Cheema ◽

Shankar Lakshman ◽

Mohammad Amin Cheema ◽

Shakeel Farrukh Durrani

Keyword(s):

Soft Tissue ◽

Reverse Flow ◽

Fasciocutaneous Flap ◽

Soft Tissue Coverage ◽

Thumb Reconstruction ◽

Flap Survival ◽

Partial Necrosis ◽

Hand Defects ◽

Web Space

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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Soft Tissue Coverage of the Mangled Upper Extremity

Seminars in Plastic Surgery ◽

10.1055/s-0035-1544170 ◽

2015 ◽

Vol 29 (01) ◽

pp. 048-054 ◽

Cited By ~ 9

Author(s):

Zhi Ng ◽

Christopher Salgado ◽

Steven Moran ◽

Harvey Chim

Keyword(s):

Soft Tissue ◽

Upper Extremity ◽

Soft Tissue Coverage

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Soft-tissue coverage for upper extremity injuries

Current Orthopaedic Practice ◽

10.1097/bco.0b013e318265dee4 ◽

2013 ◽

Vol 24 (1) ◽

pp. 73-78

Author(s):

Ryan D. Katz ◽

James P. Higgins

Keyword(s):

Soft Tissue ◽

Upper Extremity ◽

Soft Tissue Coverage ◽

Extremity Injuries

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Reverse Radial Forearm Flap to Provide Arterial Inflow to a Toe Transfer

Hand ◽

10.1177/1558944716643081 ◽

2016 ◽

Vol 12 (2) ◽

pp. 154-161 ◽

Cited By ~ 4

Author(s):

Joohak Kim ◽

Alfred P. Yoon ◽

Neil F. Jones

Keyword(s):

Soft Tissue ◽

Case Reports ◽

Radial Forearm Flap ◽

Soft Tissue Coverage ◽

Forearm Flap ◽

Arterial Inflow ◽

Radial Forearm ◽

Age Range ◽

Toe Transfer

Background: Toe-to-thumb transfer has become the gold standard for thumb reconstruction, but in badly mutilated hands, additional soft tissue coverage may be required or a suitable recipient artery may not be available. There are only 3 case reports describing the successful use of a reverse radial forearm flap for coverage of a soft tissue defect around the thumb as well as providing arterial inflow for a toe transfer, performed either simultaneously or secondarily. Methods: A single surgeon’s experience of all toe-to-hand transfers performed in conjunction with a reverse radial forearm flap between 1995 and 2014 was reviewed, including patient demographics, type of toe transfer and vascular pedicle, whether immediate or secondary, follow-up, and complications. Results: Eight toe-to-hand transfers were performed in 7 patients—3 children (age range, 3-15 years) and 4 adults (age range, 19-39 years). Three patients underwent primary toe-to-thumb transfer simultaneously with a reverse radial forearm flap, and 5 patients underwent secondary toe-to-hand transfer between 4 months and 2½ years after an initial reverse radial forearm flap. All toe transfers survived completely. Average follow-up was 5.1 years. All patients were satisfied with the function and appearance of their reconstructed thumb. Conclusion: The reverse radial forearm flap is a very reliable procedure as a “Sister” or “Siamese” flap to provide immediate arterial inflow to a simultaneous toe-to-thumb transfer, or to provide primary soft tissue coverage on the radial aspect of the hand and subsequently provide a recipient arterial inflow for a secondary toe transfer.

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