title: Anatomical basis of a proximal fasciocutaneous extension of the distal-based posterior interosseous flap that allows exclusion of the proximal posterior interosseous artery.
abstract: OBJECTIVE
  The objective of this study was to provide anatomical information for the repair of small tissue defects in the hand with posterior interosseous artery chain-link perforator flaps, a proximal fasciocutaneous extension of the distal-based posterior interosseous flap, which allows the exclusion of the proximal posterior interosseous artery.
  
  
  METHODS
  Fourteen posterior interosseous artery chain-link perforator flaps taken from human cadavers were studied by the following three methods: latex perfusion for microanatomy analysis, denture material and vinyl chloride mixed packing for cast analysis, and latex perfusion for the production of clearance specimens. Statistical analysis was performed on cutaneous perforators coming from the intermuscular septum of the extensor carpi ulnaris and the extensor digitorum communis. A cluster analysis was conducted to determine the overall distribution of perforators.
  
  
  RESULTS
  There are two main clusters of perforators at a relative distance of 21% and 48% along the ulnar head-to-lateral epicondyle interval. On average, the posterior interosseous artery extends six cutaneous perforators through the intermuscular septum of the extensor carpi ulnaris and the extensor digitorum communis. Of these six arteries, two are clinically significant perforators (0.5 mm or more in diameter) and are located 6 ± 2 cm proximal to the head of the ulna and 10 ± 1 cm distal to the lateral epicondyle of the humerus. Their mean diameters are 0.5 ± 0.1 and 0.6 ± 0.1 mm, with pedicle lengths of 16.8 ± 5.1 and 21.2 ± 12.3 mm, respectively. At the two main clusters of perforator-intensive sites, the vessel chains formed by adjacent perforators are parallel to the intermuscular septum of the extensor carpi ulnaris and the extensor digitorum communis.
  
  
  CONCLUSIONS
  This study demonstrates that the posterior interosseous artery has two main clusters of perforators in the middle and distal one-fifth of the forearm, which can be used for repairing hand defects with posterior interosseous artery chain-link perforator flaps.
authors.affiliation: Department of Orthopaedics, Zhu Jiang Hospital, Southern Medical University, Guangzhou, Guangdong Province 510282, PR China.
authors.forename: Chao
authors.initials: C
authors.lastname: Sun
authors.affiliation: Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, Guangdong Province 510515, PR China.
authors.forename: Yu-Long
authors.initials: YL
authors.lastname: Wang
authors.affiliation: Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, Guangdong Province 510515, PR China.
authors.forename: Zi-hai
authors.initials: ZH
authors.lastname: Ding
authors.affiliation: Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, Guangdong Province 510515, PR China.
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Anatomy, Yanbian University Medical College, Yanbian 133002, PR China.
authors.forename: Xiang-zheng
authors.initials: XZ
authors.lastname: Qin
authors.affiliation: Department of Orthopedics, General Hospital of Chinese PLA, Beijing 100853, PR China.
authors.forename: Hong-liang
authors.initials: HL
authors.lastname: Lee
authors.affiliation: Department of Orthopaedics, Zhu Jiang Hospital, Southern Medical University, Guangzhou, Guangdong Province 510282, PR China. Electronic address: jinanmin2008@163.com.
authors.forename: An-min
authors.initials: AM
authors.lastname: Jin
mesh_terms: D002102:Cadaver; D005542:Forearm / Q000033:anatomy & histology* / Q000098:blood supply* / Q000601:surgery; D006225:Hand / Q000033:anatomy & histology / Q000098:blood supply* / Q000601:surgery*; D006801:Humans; D008297:Male; D042282:Microdissection; D064827:Myocutaneous Flap / Q000098:blood supply*; D061525:Perforator Flap / Q000098:blood supply*; D012680:Sensitivity and Specificity; D017535:Ulnar Artery / Q000033:anatomy & histology
keywords: Anatomy; Chain-link perforator flaps; Forearm; Hand; Posterior interosseous artery