Reverse Posterior Interosseous Artery Flap: A Reliable, Comfortable and Versatile Flap for Coverage of Soft Tissue Defects of Hand

Abstract

Background: Soft tissue defects of the hands require coverage with soft, pliable full-thickness skin. The posterior interosseous artery (PIA) flap fulfils all these requirements and also has significant advantages over other flaps; it is a single-stage procedure that does not sacrifice major vascular axis of the hand. However, the dissection can be challenging and requires meticulous skill. The objective of the study was to evaluate the reverse PIA flap for coverage of hand soft tissue defects in terms of its safety, reliability, comfort, function and aesthetic appearance.Methods: Over a period of 3 years, patients with soft tissue defects over the dorsum of the hand and first web space were observed. A standard PIA flap was raised using loupe magnification under general or brachial anesthesia. The size and location of the defect were noted along with the size and success of the flap.Results: Twelve patients, including nine males and three females, were taken up for this procedure. All the flaps survived completely except one with marginal necrosis not requiring a secondary procedure. All patients were quite satisfied with the procedure and went on to resume their work within a month or two.Conclusion: PIA flap is a safe, reliable option with great versatility for coverage of hand defects, especially over the dorsum. A well-planned flap surgery done under loupe magnification affords excellent results. The entire treatment also requires a shorter hospital stay and allows the patient to return to work quickly.