Related Experiment Video
Updated: Oct 9, 2025
Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
Published on: May 23, 2025
Flow-Through Arterialized Posterior Interosseous Nerve Grafts for Digital Neurovascular Bundle Defects: Anatomical
Gilles Claro1, Nicole A Zelenski1, Thierry Balaguer1
1From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Toulouse University Hospital, Hôpital Rangueil; Department of Orthopaedic Surgery, Mayo Clinic; Departments of Plastic and Reconstructive Surgery and Orthopaedic Surgery, Institut Universitaire Locomoteur et Sport, and Service de Chirurgie Viscérale d'Urgence, Hôpital Pasteur 2, University of Côte d'Azur; Department of Plastic, Reconstructive, and Aesthetic Surgery, Orléans Hospital; and Laboratoire d'Anatomie Normale, Faculté de Médecine de Nice, Université Côte d'Azur.
Background:
Digital neurovascular bundle defects are often encountered during crush or avulsion injuries and require complex reconstruction. Use of an arterialized nerve graft (neurovascular graft) serving both as an interpositional arterial conduit and as a nerve graft could be a reconstructive option in these cases. In this anatomical study, the authors aimed to describe a neurovascular graft of the posterior interosseous nerve and a branch of the anterior interosseous artery for neurovascular bundle reconstruction of the fingers.
Methods:
Eighteen forearms were injected with red latex in order to collect the anatomical characteristics of the posterior interosseous nerve and the artery running near it.
Results:
In all cases, the posterior interosseous nerve was followed by a branch of the anterior interosseous artery: the distal dorsal branch of the anterior interosseous nerve. The origin of this artery was proximal to the radiocarpal joint, at an average of 56.5 ± 11.1 mm. The proximal and distal diameters of the branch of the anterior interosseous artery were 1.6 ± 0.2 and 1.1 ± 0.2 mm, respectively. The proximal and distal diameters of the posterior interosseous nerve were 1.2 ± 0.3 mm and 1.1 ± 0.3 mm, respectively.
Conclusions:
These results show that a potential free neurovascular graft using the posterior interosseous nerve as nerve graft and the anterior interosseous artery as an arterial bypass to reconstruct both the nerve and arterial tree of the finger could be a useful approach. The authors speculate that this graft could be used to reconstruct the neurovascular bundle of amputated or devascularized digits.
