The Role of Reverse Posterior Interosseous Artery Flap in Toe Transfer

Abstract

BACKGROUND: Reverse posterior interosseous artery (rPIA) flap is an excellent tool for the restoration of defects in the hand and upper extremity. Its reliability and versatility are well established. Compared with the other forearm flaps, it spares the main arteries to the hand. Although very few case reports used the reverse radial forearm flap to provide arterial inflow for the toe-to-thumb transfer, the role rPIA flap in such cases has yet to be described. METHODS AND MATERIALS: Five procedures involving 4 patients performed by a single surgeon to power up a toe-to-thumb transfer were reviewed. In all the cases, the first dorsal metatarsal artery was anastomosed to the transposed proximal posterior interosseous artery. RESULTS: Three patients underwent unilateral reconstruction and 1 patient had bilateral thumb base reconstruction using rPIA flaps. Secondary toe-to-thumb transfers were performed at 1–7 months after mounding up the thumb base with rPIA flaps. All the flaps and toe transfers survived completely without any partial necrosis. All patients were satisfied with the functional outcome as well as the appearance of the thumb. CONCLUSION: The use of the proximal posterior interosseous artery pedicle in rPIA flap is a safe and reliable procedure especially in cases involving traumatic loss of the thumb. In addition to the simple soft tissue coverage around the thumb base, the rPIA flap also provides a satisfactory arterial inflow during subsequent toe-to-thumb transfer.