Posterior Interosseous Artery Flap for Resurfacing Posttraumatic Soft Tissue Defects of the Hand

Abstract

The need for soft tissue coverage of large defects in the hand and the wrist following trauma is a common problem for hand surgeons. Flap coverage of these defects can be either in the form of distant or regional flaps. The posterior interosseous artery flap recently has emerged as a front runner in these situations by its virtue to preserve both the major arteries to the hand. Thirty-two posterior interosseous artery flaps were used in 32 patients with complex soft tissue defects of the hand. All these defects were posttraumatic. There were associated skeletal and soft tissue injuries in 20 patients. The donor site was closed either primarily or by a split skin graft depending on the size of the defect. All flaps healed well, and there were no incidences of flap necrosis. The donor site required a split skin graft in 24 patients. The flap was bulky in one patient and transient extensor carpi ulnaris weakness was seen in three patients. The posterior interosseous artery flap is a versatile flap for coverage of soft tissue defects of the hand. Good aesthetic results can be achieved with minimal donor site morbidity. Harvesting the flap requires a precise surgical technique and as many perforators as possible should be preserved to ensure flap viability.

Altering the Marking of the Reverse Posterior Interosseous Artery Flap

“…Thus, shifting our distal flap landmark to the ulnar head has made a flap elevation with a small distal skin paddle easy and quick. Preoperative hand-held Doppler examination is usually used to locate the vessel [10] , but as practiced by Ashok G [11] , we too dissect the flap from radial to ulnar and identify the posterior interosseous vessels.…”

Versatility of the Posterior Interosseous Artery Flap: Emphasis on Powering Up the Toe Transfer

“…Although the proximal axis of rotation of the rPIA flap limits the distal reach to the metacarpophalangeal (MCP) joint level, various modifications to extend the maximal reach of the rPIA flap even to distal interphalangeal joint level have been reported. They include the skin over the supinator, 3,5,22 more distal dissection along the transverse anastomotic branch, 19 splitting of the skin bridge between the pivot point and the defect, 28 using an exteriorized pedicle 31 and the extended fascia or skin flap, 5,21 and bowstringing it across to maintain an extended wrist. 25 Zaidenberg et al 32 used a dorsal intercarpal arch through the fifth extensor compartment artery as a pivot point of the PIA flap and extended the distal reach of the PIA flap to the fingertips.…”

Use of Free Modified Innervated Posterior Interosseous Artery Perforator Flap to Repair Digital Skin and Soft Tissue Defects

“…The freed forearm posterior interosseous artery perforator flap used to repair hand skin and soft tissue defects can avoid damage of the main blood vessel, providing the flap with a thinner profile and a reliable blood supply. At present, the freed forearm dorsal interosseous artery perforator flap has been broadly applied in repairing regions between the thumb and index fingers, back of the hand, palm, wrist, thumb and even finger trauma and congenital defects [23][24][25][26]. This report describes the successful use of the modified innervated posterior interosseous free perforator flap for the repair of digital defects.…”