Applied Anatomy And Clinical Study Adult Free Interosseous Artery Perforator Flap

Objective To provide anatomic evidence for the clinical application of posteriorinterosseous artery perforator flap by observing the origin, number, position, lengthsand the external diameters of cutaneous branches of posterior interossous arteryperforator flap.Methods20fresh upper limbs from Chinese adult cadavers were provided forthe micro-anatomy injected with red latex.Collecting data by observing the branchesof posterior interosseous artery,the number and position of perforators,and theregularities of distribution of the perforators in these area,their average extermaldiameters at the origin,an average pre-fascial length, the diameter and position of theposterior antebrachial cutaneous nerve. One of the specimens was provided for thesimulated operation of the posterior interosseous artery perforator flap.All the datawere analyzed with SPSS13.0statistical software.Results Observations of20specimens show:the posterior interosseous arterywere originated from the common interossea artery,passed interosseous membranes toregions antibrachii dorsalis from beneath lateral epicondyle of humerus (74.60+1.24)mm,divided into arteriae interossea recurrens, ulnar branches and radial branches.Inthe20specimens,20perforators come from the radial branches of posteriorinterosseous artery(on average1in each forearm) were found. The perforators had anaverage starting diameter of (0.67±0.07)mm, an average pre-fascial length of(44.82±2.24)mm.Totally146ulnar branches perforators were found in20specimens(on average7.3). The external diameter of vessel pedicle was (0.44±0.08)mm, anaverage pre-fascial length of (19.93±7.26)mm. The perforators interlink with eachother to form longitudinal vascular anastomosis, providing anatomic evidence for theapplication of posterior interosseous artery perforator flap. The diameter of theposterior antebrachial cutaneous nerve was (0.32±0.07)mm at the point about9.5cmto the proximal ulna head.Conclusions The presence of posterior interosseous artery perforator is consiste-nt. At the point7cm～10cm to the proximal ulna head,the diameter of the ulnarbranches perforators was (0.50±0.06)mm.It offers adequate vascular pedicle and desirable caliber of vascular anastomosis. And its anatomic characteristic is verysuitable for free grafting and pedicle skin flap reversing. Objective: To probe the feasibility and therapeutic effect of repairing defects ofsoft tissue defects in the hands with the posterior interosseous artery perforator flap.Methods: Twenty-five patients with finger soft tissue defects were treated withthe posterior interosseous artery perforator flap by free transfer from February2011toOctober2012.Four cases were treated with radial branches perforator flaps repair,tw-enty-one cases were treated with ulnar branches perforator flaps repair, flap sizesranging from3.0cm×2.0cm～6.0cm×3.5cm. The patients were evaluated at3,6,9and12months on the postoperative follow-up parameters including flap contour,restoration of touch sensation, as well as the shape and motor function of hands.Results: Twenty-two flaps survived smoothly in this group. Only two flaps hadvein articulo and one flaps had artry articulo.The flaps also survived after the articulowas removed by suitable healing.There is about0.8cm2skin suffered healing delayedin one case.All of flaps were primarily healed. Donor sites only had linear scars.In3~12months (8months on average) follow up, the appearance and texture of the flapswere in good condition;the feeling of all flaps had recovered to S3and the shape andmotor function of hand recovered.Conclusions: The posterior interossesous artery perforator flap has clinicalfeasibility and does not sacrifice a major artery of forearm. It has desirable caliber ofvasudar anastomsis with ateria digitalis.It’s color and soft texture are close to those offingers. It’s an ideal option to repair finger skin and soft tissue defects.