The Anterior Interosseus Artery Perforator Flap: Anatomical Dissections and Clinical Study

Area of Science:

• Plastic Surgery
• Hand Surgery
• Reconstructive Surgery

Background:

• Reconstructing upper extremity deformities presents challenges for surgeons.
• Various flaps exist, each with pros and cons. Local flaps like the radial artery forearm flap and posterior interosseus artery flap are common.
• Perforator propeller flaps are increasingly used for upper extremity resurfacing, but the anterior interosseus artery perforator flap is less described.

Purpose of the Study:

• To evaluate the anatomical feasibility and clinical utility of the anterior interosseus artery perforator flap for upper extremity reconstruction.
• To assess the outcomes of using this flap in a series of patients with hand and wrist defects.

Main Methods:

• Anatomical dissection of five upper extremities to identify the anterior interosseus artery perforator.
• Retrospective review of 12 patients who underwent reconstruction with this flap between November 2008 and May 2014.
• Flap procedures were performed by a single surgeon.

Main Results:

• The anterior interosseus artery perforator was identified in 80% (4/5) of cadaver limbs, typically in the fifth extensor compartment.
• Out of 12 flaps, one experienced complete necrosis and one had partial necrosis.
• The patient with complete flap necrosis required subsequent skin grafting; partial necrosis cases healed secondarily.

Conclusions:

• The anterior interosseus artery perforator flap is a viable and important reconstructive option for hand and wrist defects.
• This flap should be considered by plastic surgeons managing complex upper extremity deformities.
• The study highlights the potential of this less commonly described flap in reconstructive surgery.