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Tiengo C, Dalla Venezia E, Lombardi M, et al. Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources. Plast Reconstr Surg Glob Open. 2016;4(7):e794doi: 10.1097/GOX.0000000000000760.
Tiengo, C., Dalla Venezia, E., Lombardi, M., & Bassetto, F. (2016). Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources. Plastic and reconstructive surgery. Global open, 4(7), e794. https://doi.org/10.1097/GOX.0000000000000760
Tiengo, Cesare, et al. "Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources." Plastic and reconstructive surgery. Global open vol. 4,7 (2016): e794. doi: https://doi.org/10.1097/GOX.0000000000000760
Tiengo C, Dalla Venezia E, Lombardi M, Bassetto F. Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources. Plast Reconstr Surg Glob Open. 2016 Jul 11;4(7):e794. doi: 10.1097/GOX.0000000000000760. eCollection 2016 Jul. PMID: 27536473; PMCID: PMC4977122.
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Plast Reconstr Surg Glob Open. 2016 Jul 11;4(7):e794. doi: 10.1097/GOX.0000000000000760. eCollection 2016 Jul.

Improvement of the Rotation Arch of the Posterior Interosseous Pedicle Flap Preserving Both Reverse Posterior and Anterior Interosseous Vascular Sources.

Plastic and reconstructive surgery. Global open

Cesare Tiengo, Erica Dalla Venezia, Matteo Lombardi, Franco Bassetto

Affiliations

  1. Clinic of Plastic Surgery, Department of Surgery, Padua University Hospital, University of Padua, Padua, Italy.

PMID: 27536473 PMCID: PMC4977122 DOI: 10.1097/GOX.0000000000000760

Abstract

PURPOSE: The reverse posterior interosseous artery flap has several advantages, not sacrificing any major blood vessel, but its relatively short pedicle limits the use to cover defects up to the metacarpophalangeal joint. Our purpose is to demonstrate that the ligature of the anterior interosseous artery (AIA), proximal to the communicating branch with the posterior interosseous artery, leads to an improved flap rotation arch, preserving both vascular sources.

METHODS: Sixteen fresh cadavers with latex perfusion were analyzed before and after our technique of elongation, and the so-obtained measures were standardized in "percentage of elongation of the pedicle." Eight patient with the loss of substance at the dorsal aspect of the hand have been treated with this technique, and results were evaluated in terms of flap survival and complication rates.

RESULTS: The medium length of the pedicle in the normal flap was 10.8 cm, and after the section of the AIA, the medium length of the pedicle was 13.6 cm with a medium increase of 2.8 cm. It means a medium increase of 24% of the length of the pedicle. In all patients treated, full coverage of the defect was obtained, and we did not experience major complications.

CONCLUSIONS: This anatomical study supported by our clinical experience demonstrates that the use of the variant described above permits to reach more distal part of the hand without being afraid to stretch the pedicle because of the connection with the anastomotic arcades of the AIA at the wrist reducing the risk of ischemia of the flap.

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