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 4th and 5th 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.