Radial artery perforator propeller flap for the posterior interosseous artery flap donor site closure

Abstract

Introduction: The posterior interosseous artery flap (PIAF) has been used for many years for a successful coverage of the defects of dorsal aspect of the hand. Recently a concern was raised regarding donor site morbidity, as skin grafting has poor functional and aesthetic outcomes. We present a case report with an alternative technique for the donor site closure with radial artery perforator propeller flap. So far, we have used this technique in 4 cases. Case report: A 50 years old male was hospitalized due to a crush injury to the right hand. Examination revealed fractures of 4 th and 5 th metacarpal bone, crashed intrinsic muscles, rupture of extensor tendons and 5x7 centimeters soft tissue defect. Bone fixation was done, tendons were sutured primarily. For the hand's soft tissue defect a PIAF was used. To cover the defect on the donor site and to avoid skin grafting a perforator propeller flap was raised. The flap was based on a single perforator from the radial artery. No healing problems occurred. Conclusions: Perforator based on radial artery at dorsoradial aspect of forearm, could be used as propeller flap for soft tissue covering after PIAF. By covering the donor site with a perforator flap skin grafting is avoided, faster healing, good skin color and texture match is achieved.