Clinical Results of the Reverse Posterior Interosseous Artery Flap with Only the Middle Forearm Perforator

Abstract

The reverse posterior interosseous flap is useful for skin coverage of the hand. However, the reliability of this flap has been questioned, and it has not been decided if the range of the flap extends to the lateral condyle of the humerus. The limit of the proximal range of the flap varies in whether to include the perforator of the proximal third of the forearm. In general, the motor branch of the extensor carpi ulnaris nerve is frequently on the posterior interosseous artery. In these cases, the perforator of the proximal third cannot be included in the flap. We designed the flap to include 1 cm distal to the mid-point of the forearm and used only the middle forearm perforator. We performed this reverse flap in 10 cases. The size of the flap was 9 cm × 4 cm ~ 13 cm × 4 cm. The average range of the proximal edge of the flap to the lateral condyle of the humerus was 3.8 cm. The flap survived in all cases. We concluded that the posterior interosseous flap is a reliable and safe flap with only the middle forearm perforator within the range of 2 ~ 4 cm from the lateral condyle of the humerus.