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.

Traumatic injury of radial and ulnar artery with perfusion of the hand through the median artery: a case report

Case description: A young male patient with a complete section of the ulnar and radial arteries preserved the perfusion of the hand through an anatomical variant, the median artery, identified by angiotomography. Clinical Findings: A wound in the distal third of the left forearm with present pulses and adequate hand coloration. An angiotomography of the upper left limb showed a median artery originating as a continuation of the anterior interosseous artery and ending in the palm of the hand with an incomplete superficial palmar arch. Treatment and Outcomes: Ligation of both radial and ulnar arteries was performed. It was not possible to follow up with the patient. Clinical Relevance: Forming the superficial and deep palmar arches, the irrigation of the hand comes from the ulnar and radial arteries, which can compromise the viability of the limb when injured. The median artery is present in 0.6-21.1% of the population, originates from the anterior interosseous artery (branch of the ulnar), accompanies the median nerve in its path and ends in the palm joining the superficial palmar arch. Diagnostic imaging is a key tool for assessing arterial circulation and characterizing upper limb vascular lesions. Knowledge of the anatomical variations of the arterial supply of the hand, including variability of the superficial palmar arch, is crucial for the safety and success of hand surgeries.

The posterior interosseous artery flap versus the adipofascial radial artery perforator flap in reconstruction of firecracker and homemade bomb blast injuries of the hand

Background: The soft tissues of the radial aspect of the hand are predominantly affected in firecracker and homemade bomb blast injuries. In such cases, regional flap options are quite appealing for defect coverage. We have compared the outcomes of using two pedicled regional forearm flaps in these injuries, the posterior interosseous artery flap (PIAF) and the adipofascial radial artery perforator flap (ARAPF).Methods: 37 patients underwent reconstruction of the hand with PIAF (20 cases) and ARAPF (17 cases) between January 2014 and December 2019. They were compared with regards to patient demographics, reconstruction techniques, short-term and long-term functional and aesthetic outcomes using the disabilities of the arm, shoulder and hand (DASH) score and the subjective satisfaction score (SSS).Results: All our flaps survived without any major complications affecting long-term outcome. We found no statistically significant difference between the two flaps in terms of patient demographics, flap paddle size, duration of hospital stay, DASH score and SSS for recipient site. However, significant difference was noted in the duration of surgery, method of donor site closure and SSS for the donor site.Conclusions: Both the PIAF and ARAPF can be considered in cases of soft tissue defects of the hand from firecracker or bomb blast injuries. Both preserve the major arteries of the hand while still having reliable vascular pedicle.

A cadaveric study of brachial artery and its variations with its ontogenic basis: An Anatomical Perspective

Introduction: Conventional knowledge of the brachial artery, the principal artery of the upper limb & its branches has played a major role in vascular surgeries. Literature along with various cadaveric & clinical studies suggest that brachial artery vary widely in origin, course and branching pattern. The great variability of this arterial pattern may be attributed to the failure of regression of some paths of embryonic arterial trunks. Anatomical knowledge of this principal artery and its variations has many clinical implications especially in surgeries related to orthopedic and vascular re-constructive procedures. MATERIALS AND METHODS: The present study was conducted on 56 upper limbs of different age group and sex (19 Male and 9 Female) The brachial arteries were identified and branching pattern and relations of the brachial artery with brachial plexus in arm was observed and presence or absence of variations were documented. Results: Out of 56 upper limbs studies, 53 (94.64%) limbs showed normal morphological pattern of brachial artery, 3 (5.35%) limbs showed superficial brachial artery, 1 limb (1.78%) showed tortuous and SBA with trifurcation into radial artery, ulnar artery and common interosseous artery in the cubital fossa. Conclusion: The study of Brachial artery and variation in its course and branching pattern is clinically important for surgeons, ortho-paedicians operating on the supracondylar fracture of humerus and radiologists performing angiographic studies on the upper limb. KEY WORDS: Common Interosseous Artery, Median Nerve, Superficial Brachial Artery, Trifurcation, Ulnar Artery.