CC BY-NC-ND 4.0 · Revista Iberoamericana de Cirugía de la Mano 2018; 46(02): 106-112
DOI: 10.1055/s-0038-1676083
Original Article | Artículo Original
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Anatomical Study of Periosteal Vascularization of the Forearm: Design of Vascularized Periosteal Flaps

Artikel in mehreren Sprachen: English | español
Sergi Barrera-Ochoa
1   Hospital Sant Joan de Déu, Barcelona, Spain
2   Institut Català de Traumatologia i Medicina de l'Esport (ICATME). Barcelona, Spain
David Campillo-Recio
2   Institut Català de Traumatologia i Medicina de l'Esport (ICATME). Barcelona, Spain
Jorge Knorr
1   Hospital Sant Joan de Déu, Barcelona, Spain
Xavier Mir-Bullo
2   Institut Català de Traumatologia i Medicina de l'Esport (ICATME). Barcelona, Spain
Alfonso Rodríguez-Baeza
3   Departamento de Embriología y Anatomía Humana, Universidad Autónoma de Barcelona. Barcelona, Spain
Francisco Soldado
1   Hospital Sant Joan de Déu, Barcelona, Spain
› Institutsangaben
Weitere Informationen


25. Mai 2018

10. Oktober 2018

07. Dezember 2018 (online)


Introduction Vascularized periosteal flaps (VPFs) have proven to be a useful technique for the treatment of unfavorable biological situations in children, with excellent results due to their osteogenic potential. The objective of this work is to present a detailed anatomical description of the periosteal vascularization of the radius and ulna, as well as the design of the forearm VPFs.

Methods Anatomical study with 10 fresh-frozen specimens with antegrade injection of green colored latex. Periosteal branches of the radius and ulna, septocutaneous branches, and muscular branches were dissected. The size of the pre and postdissection flaps was measured, as well as the length of the vascular pedicles.

Results The four vascular axes studied were the anterior interosseous vascular axis (AIA), radial axis (RA), ulnar axis (UA), and posterior interosseous vascular axis (PIA). The AIA (volar-radial VPF): an average of 16.2 periosteal branches were obtained, with a mean distance of 6.6 mm between them. The mean size of the VPF was 41.3 cm2 pre-dissection and 32.4 cm2 post-dissection. The average pedicle length was 16.1 cm. Vascular RA (radial VPF): an average of 20.8 branches was found, with a mean VPF size of 54.8 cm2predissection, and 39.3 cm2 post-dissection. The average pedicle length was 20.2 cm. Vascular PIA (dorsal-ulnar VPF): an average of 12.8 periosteal branches were obtained, with the mean VPF size being 26.2 cm2 pre-dissection and 20.4 cm2 post-dissection. The average pedicle length 12.6 cm. Vascular UA (ulnar VPF): an average of 10.2 periosteal branches were obtained with a mean VPF size of 37.5 cm2 pre-dissection and 28.2 cm2 post-dissection. of the average pedicle length was 14.8 cm.

Conclusions We have described four new VPFs, with the most useful and versatile being the dorsal-ulnar VPF, based on the PIA, and the volar-radial, based on the AIA. The main advantages of these flaps with respect to microsurgical techniques are the simplicity and speed of the technique, its elasticity and adaptability to the recipient bed, as well as its versatility.

  • References

  • 1 Qi B, Yu A, Zhang G. , et al. The treatment of displaced femoral neck fractures with vascularized great trochanter periosteal flap transposition in children. Microsurgery 2008; 28 (01) 21-24
  • 2 Soldado F, Fontecha CG, Barber I. , et al. Vascularized fibular periosteal graft: a new technique to enhance bone union in children. J Pediatr Orthop 2012; 32 (03) 308-313
  • 3 Soldado F, Knörr J, Haddad S. , et al. Vascularized tibial periosteal graft in complex cases of bone nonunion in children. Microsurgery 2015; 35 (03) 239-243
  • 4 Soldado F, Diaz-Gallardo P, Sena-Cabo L. , et al. Vascularized fibular grafts extended with vascularized periosteum in children. Microsurgery 2017; 37 (05) 410-415
  • 5 Soldado F, Garcia Fontecha C, Haddad S, Hernandez-Fernandez A, Corona P, Guerra-Farfan E. Treatment of congenital pseudarthrosis of the tibia with vascularized fibular periosteal transplant. Microsurgery 2012; 32 (05) 397-400
  • 6 Finley JM, Wood MB, Acland RD. Osteogenesis from periosteal autografts in ulnar defects in dogs. J Microsurg 1979; 1 (03) 203-207
  • 7 Mathoulin C, Gilbert A, Azze RG. Congenital pseudarthrosis of the forearm: treatment of six cases with vascularized fibular graft and a review of the literature. Microsurgery 1993; 14 (04) 252-259
  • 8 Kamrani RS, Mehrpour SR, Sorbi R, Aghamirsalim M, Farhadi L. Treatment of nonunion of the forearm bones with posterior interosseous bone flap. J Orthop Sci 2013; 18 (04) 563-568
  • 9 Cheema TA, Lakshman S, Cheema MA, Durrani SF. Reverse-flow posterior interosseous flap-a review of 68 cases. Hand (N Y) 2007; 2 (03) 112-116
  • 10 Barrera-Ochoa S, Velez R, Rodriguez-Baeza A, De Bergua-Domingo JM, Knörr J, Soldado F. Vascularized ulnar periosteal pedicled flap for forearm reconstruction: Anatomical study and a case report. Microsurgery 2017
  • 11 Penteado CV, Masquelet AC, Romana MC, Chevrel JP. Periosteal flaps: anatomical bases of sites of elevation. Surg Radiol Anat 1990; 12 (01) 3-7
  • 12 Diaz-Gallardo P, Knörr J, Vega-Encina I. , et al. Free vascularized tibial periosteal graft with monitoring skin island for limb reconstruction: Anatomical study and case report. Microsurgery 2017; 37 (03) 248-251
  • 13 Akin S, Ozgenel Y, Ozcan M. Osteocutaneous posterior interosseous flap for reconstruction of the metacarpal bone and soft-tissue defects in the hand. Plast Reconstr Surg 2002; 109 (03) 982-987
  • 14 Andro C, Richou J, Schiele P, Hu W, Le Nen D. Radius graft pedicled on the anterior interosseous artery for recurrent ulnar nonunion. Orthop Traumatol Surg Res 2011; 97 (4, Suppl): S12-S15
  • 15 Pagnotta A, Taglieri E, Molayem I, Sadun R. Posterior interosseous artery distal radius graft for ulnar nonunion treatment. J Hand Surg Am 2012; 37 (12) 2605-2610
  • 16 Shahryar Kamrani R, Farhoud AR, Nabian MH, Farhadi L. Treatment of Nonunion of Forearm Bones Using Radial Forearm Bone Flap. Trauma Mon 2015; 20 (04) e22622