The reverse-flow posterior interosseous island flap was described by Zancolli and Angrigiani in 1985. Many subsequent reports have altered some elements of flap design, questioned the reliability of the pedicle, redefined flap dimensions, and described various uses and limitations of the flap. This report presents a 10-year experience with modifications of the reverse-flow posterior interosseous (RFPI) flap at a single center in India. Fifty-three flaps were performed on patients from 4-56 years of age. All were used for treatment of defects of the dorsal or palmar hand, first webspace, wrist, or forearm. The authors describe their technique, which involves a proximal-to-distal exposure of the vessels from both sides of the intermuscular septum, rather than the distal-to-proximal approach described in the original manuscript. The authors feel this facilitates identification of the vessels, due to their larger size in the proximal forearm, making the dissection safer. Various modifications of the shape of the subcutaneous distal pedicle are described to facilitate flap transposition and insetting without vascular compromise. Flap dimensions varied from 5 x 2.5 cm to 21 x 10 cm. All flaps survived, although there was tip necrosis in 4/53 flaps (7.5%). Ten of 53 flaps (19%) demonstrated congestion and a "pincushion effect." Anatomy of the pedicles was consistent in all dissections. No functional motor deficits were identified postoperatively.
This paper presents a substantial experience of successful reconstructive procedures using a technically-demanding pedicle flap. Although the RFPI flap is not new, this paper does add to the understanding of the technical challenges in flap harvest and design, potential pitfalls in pedicle transfer, and limits of flap size in both minimum and maximum degrees. As such it is a valuable addition to the growing "virtual flap atlas" to which reconstructive surgeons can refer in facing challenging defects such as these.
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Plastic & Reconstructive Surgery 111: 2364-2369, 2003.