“…The major disadvantage of the PIAF is venous congestion problems that can occur because it is a reverse flap (Balakrishnan, Kumar, & Hussain, 2003;Brunelli, Valenti, Dumontier, Panciera, & Gilbert, 2001;Dogra, Singh, Chakravarty, & Basu, 2006;Ege, Tuncay, & Ercetin, 2003;Lu, Gong, Lu, & Wang, 2007). Many modifications have been described to overcome these venous problems, including using a wider pedicle to raise the flap, adding a fascia to the pedicle, adding a superficial vein to the pedicle, and making venous anastomoses (Acharya, Bhat, & Bhaskaranand, 2012;Fong & Chew, 2014;Ozalp, Elbey, Aydin, & Ozkan, 2016;Yazar, Chen, & Mardini, 2008). In this report, we present our experience with venous super-drained posterior interosseous artery flaps VS-PIAF for reconstruction of hand defects of 17 patients, which we performed using a distal end-to-end superficial venous anastomosis to overcome venous congestion problems.…”