The reverse posterior interosseous flap and its composite flap: experience with 201 flaps.
OBJECTIVE
To introduce our experiences of using the reverse posterior interosseous flap and its composite flap.


METHODS
In the series of 201 cases, the fasciocutaneous flap was used to cover skin defects over the distal 1/3rd forearm, wrist and hand in 174 cases. The composite flap with the vascularised ulna bone graft was used to reconstruct the thumbs in 11 cases, and with the vascularised tendon graft was used to repair tendon defects with skin defects in 16 cases. The size of the ulna graft was 3-6cm in length and 1-2cm in width. The 4-7cm tendon graft was obtained from the extensor digiti quinti or extensor carpi ulnaris. The size of the flaps ranged from 5cmx4cm to 16cmx10cm.


RESULTS
One flap failed completely. Of the other 200 flaps which survived 16 cases had venous congestion and had partial necrosis at the distal end. The size of the necrotic area ranged from 1 to 4cm in length. Ninety-three patients were followed up for at least 6 months, and included 10 patients with composite flaps. Generally, the flap matched the surrounding skin. But 10 cases had a lipectomy. The sensibility did not recover or achieved S1 within 6 months. For the extensor tendon defect, the function of finger extension was nearly normal and tenolysis was not required. In contrast, tenolysis was required after the flexor tendon reconstruction. However, these patients refused surgery. The bone grafts were healed in 3 months. The reconstructed thumb looked abnormal and lacked normal sensibility, although the patients used them. The linear scar line was conspicuous over the dorsum of the forearm.


CONCLUSIONS
The reverse posterior interosseous flap is a reliable method to cover skin defects over the distal 1/3rd of the forearm, the wrist and hand. The composite flap with a vascularised tendon graft is an optimal reconstructive option for any extensor tendon loss (III zone) associated with a skin defect. Using the composite flap with a vascularised bone graft or combined with the digital neurovascular flap is another way to reconstruct the thumb.
Lu
Lai-Jin
LJ
Department of Hand Surgery, The First Hospital of Ji Lin University, No. 1, Xin Min Street, Chang Chun, Ji Lin 130021, PR China.
Gong
Xu
X
Lu
Xin-Min
XM
Wang
Ke-Li
KL
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006085:Graft Survival; D006230:Hand Injuries / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000517:prevention & control; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply* / Q000473:pathology; D014945:Wound Healing