One-stage repair of hypospadias

Abstract

The distally based posterior interosseous island flap is very versatile. I have used it on nine occasions as a fascio- cutaneous flap for post-burn contracture of the first web space, twice as an osteocutaneous flap for distal thumb reconstruction and once as a vascularised bone flap for a metacarpal replacement. However, there seem to be two significant problems with this flap. I have failed to find the posterior interosseous vessels on three occasions. Once, the vessels only became posterior to the interosseous membrane in the distal forearm but the more proximal vessel was represented by large perforating branches in the proximal forearm; I attempted to dissect out the branches and divided the interosseous membrane in order to raise a distally based vascular pedicle. This flap never perfused and died. On two occasions, I found no posterior vessels in the distal forearm and only a small posterior interosseous pedicle coming through the supinator, which disappeared in the middle third of the forearm. There were, however, large septo- cutaneous perforators coming through the interosseous membrane in the distal forearm.