Hc. Chen et al., MICROVASCULAR FREE POSTERIOR INTEROSSEOUS FLAP AND A COMPARISON WITH THE PEDICLED POSTERIOR INTEROSSEOUS FLAP, Annals of plastic surgery, 36(5), 1996, pp. 542-550
The posterior interosseous flap has been used as a pedicled flap for c
overage of hand wounds. However, the pedicled flap is associated with
partial or even complete loss when there is venous congestion. This ha
ppens because it depends on retrograde venous drainage. Another pitfal
l of the pedicled posterior interosseous flap is the undetected damage
to the communicating vessels between the anterior and posterior inter
osseous arteries before surgery. This would result in failure if the f
lap is used as a distally based flap. Thirty-four patients had been re
constructed with the microvascular free posterior interosseous flap. T
he free flap has a large draining vein. Flap survival rate was 97%, Th
ere was no venous congestion and no partial loss of the flap. It is th
in, sensate, and reliable. The free posterior interosseous flap is ind
icated for coverage of the following wounds: (1) first web space and t
humb, (2) radial side of the index and ulnar side of the small finger
if a cross-finger flap cannot be used, and (3) defects at the dorsum o
f multiple fingers. It can also be used as a free fascial flap. The fr
ee posterior interosseous flap provides a reliable option for coverage
of hand wounds. Previously, another 14 patients with hand wounds had
been reconstructed with a pedicled posterior interosseous flap. The re
sults of pedicled and free posterior interosseous flaps are compared.