How reliable is the posterior interosseous flap? A review of 88 patients

Abstract.

The distally-based, reverse posterior interosseous flap can be used to reconstruct soft tissue defects in the region of the hand, provided there is an intact anastomotic network of the posterior and anterior interosseous system at the wrist. Between 1986 and 2000, 88 flap procedures were planned. Anatomical variations were recorded in 21 patients (24%) and precluded the use of the flap in five patients. In the remaining 16 patients, flap dissection was more difficult due to anatomical variations. There was a complication rate of 23%, including haematoma, congestion, infection or technical errors, which resulted in flap necrosis of variable degrees in 11 patients (13%). In case of haematoma, flap loss could be reduced by early revision surgery. There was no statistical correlation between anatomical variations and complications or flap loss. Secondary flap corrections, including defatting and remodelling, were commonly performed in due course. Knowing the limitations of the posterior interosseous flap, fasciocutaneous flaps are considered ideal to reconstruct soft tissue defects or contractures of the thumb web and the dorsal hand because of good tissue matching. Fascial flaps are a good option for palmar defects or to wrap neurolized nerves.