Comparison of free and reversed pedicled posterior interosseous cutaneous flaps

The posterior interosseous cutaneous flap is characterized by its thinness and the adjustable length of its vascular pedicle. This flap can be used both as a free and reversed vascular pedicled flap. We applied the free flap mostly for reconstruction of the digits, and the reversed vascular pedicled flap for soft-tissue defects of the proximal hand. Of 17 free flaps, 16 survived completely, and 1 developed partial necrosis. Eleven flaps were elevated as reversed vascular pedicled flaps, three of which were combined with the lateral arm flap to cover large defects. In these three combined flaps, the posterior radial collateral artery was anastomosed to an artery in the recipient site to enhance circulation; all three flaps survived completely. Operative time was 30 to 40 minutes shorter for the reversed vascular pedicled flaps. Two of the remaining eight reversed vascular pedicled flaps developed partial necrosis. The flap success rate was thus higher in the free flaps than in the reversed vascular pedicled flaps.