Coverage of skin defects in spaghetti wrist trauma: application of the reverse posterior interosseous flap and its anatomy.

BACKGROUND: To introduce the application of reverse posterior interosseous flap in spaghetti wrist trauma.
METHODS: From 2003 to July 2005, 12 cases of skin defects over the volar wrist in spaghetti wrist trauma were covered by the reverse posterior interosseous flap. The size of the skin defects ranged from 5 cm x 4 cm to approximately 10 cm x 6 cm when the wrist was in the neutral position. The skin defects over donors were covered by split skin graft.
RESULTS: All flaps and skin grafts survived uneventfully. The follow-up period was at least 3 months. The texture, color, and thickness of the skin paddle matched the surrounding skin. The sensation of the flap recovered to S0 to S1 on a five-point scale. The functional recovery of the hand and fingers was dependent on the original injuries to the tendons and nerves.
CONCLUSION: The reverse posterior interosseous flap is a suitable alternative to cover skin defects in spaghetti wrist. The pedicle should include 2 cm of fascia and septum between the extensor carpi ulnaris and extensor digiti quinti proprius, and the subcutaneous tunnel should be wide enough to avoid venous congestion. Temporarily blocking the proximal end of the posterior interosseous artery to observe the blood supply of the flap is helpful to avoid its failure before completing the flap.