Clinical Experience with the Free Anterior Interosseous Flap

Forearm flaps can be used as free tissue transfers safely and with versatility. Forearm skin is thin and the vascular anatomy is constant. Although radial the forearm flap is the most popular forearm flap, several flaps can be harvested based on different pedicles. The anterior interosseous flap is one of those alternatives; however, it has not gained popularity among other options. This flap is harvesrted on the dorsal side of the forearm based on the dorsal septocutaneous branch of the anterior interosseous artery.

Between January 2002 and April 2005, seven free anterior interosseous flaps were performed. Four of them were used for hand coverage, including digits and the dorsum of the hand; three flaps were used for head and neck reconstruction. Only one donor site was closed directly and the others required skin graft.

All flaps survived completely except for one marginal loss. Reexploration was done in one patient because of hematoma, and partial loss was observed in this patient.

The advantages of the free anterior interosseous flap are as follows; 1) preservation of major arteries; 2) good color and texture match, especially for hand defects; 3) the vascular pedicle is large and long enough; 4) composite flaps are possible; 5) a fascial flap can be harvested to reduce donor-site morbidity. The disadvantages of this flap include unsightly donor area scarring, which is more or less common in all forearm flaps, and a technically demanding dissection.

Based on the authors' reported experience, the free anterior interosseous flap is a versatile option for upper extremity and head and neck reconstruction in a selected group of patients.