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Updated: May 12, 2026

Procurement and Perfusion-Decellularization of Porcine Vascularized Flaps in a Customized Perfusion Bioreactor

Procurement and Perfusion-Decellularization of Porcine Vascularized Flaps in a Customized Perfusion Bioreactor

Published on: August 1, 2022

Reverse bipaddle posterior interosseous artery perforator flap.

Yi Xin Zhang¹, Yunliang Qian, Zheming Pu

¹Shanghai, People's Republic of China; Singapore; Florence and Pisa, Italy; Durham, N.C.; and Philadelphia, Pa. From the Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine; the Department of Plastic, Reconstructive, and Aesthetic Surgery, Singapore General Hospital; the Maxillofacial Surgery Unit, Hospital of Florence; the Division of Plastic, Reconstructive, Maxillofacial, and Oral Surgery, Department of Surgery, Duke University Medical Center; the Department of Orthopedic Surgery, University of Pennsylvania; and the Plastic and Reconstructive Surgery Unit, Hospital of Pisa.

Plastic and Reconstructive Surgery

|April 2, 2013

Summary

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The reverse bipaddle posterior interosseous artery perforator flap effectively reconstructs hand defects, even in multiple areas simultaneously. This refined technique minimizes donor-site issues and offers reliable vascularity for complex hand reconstructions.

Area of Science:

Plastic Surgery
Hand Surgery
Microsurgery

Background:

The reverse posterior interosseous artery perforator flap has limitations including short pedicle length and donor-site morbidity.
Previous refinements addressed some drawbacks, but reconstructing multiple hand subunits in one stage remained challenging.

Purpose of the Study:

To present a variant of the distally based posterior interosseous artery perforator flap to expand its applications.
To minimize donor-site morbidity in hand defect reconstruction.

Main Methods:

Review of eleven cases using the reverse bipaddle posterior interosseous artery perforator flap.
Reconstruction of defects in various hand locations including the first web space, thumb, dorsum, palm, and wrist.

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An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps

Published on: December 5, 2025

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Last Updated: May 12, 2026

Procurement and Perfusion-Decellularization of Porcine Vascularized Flaps in a Customized Perfusion Bioreactor

Procurement and Perfusion-Decellularization of Porcine Vascularized Flaps in a Customized Perfusion Bioreactor

Published on: August 1, 2022

An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps

An Experimental Human DIEP Flap Model to Investigate Preservation Strategies for Vascularized Composite Allografts and Free Flaps

Published on: December 5, 2025

Main Results:

Successful treatment of eleven patients with no major complications using the bipaddle flap.
Type A variant used in seven cases for defects in two hand units; Type B variant in four cases for large single-unit defects.
Direct donor-site closure achieved in all Type B cases, with high patient satisfaction.

Conclusions:

The reverse bipaddle posterior interosseous artery perforator flap is a reliable method for covering large, multi-subunit hand defects.
Recommendations are provided for optimizing skin island location, pedicle dissection, and flap handling.