Posterior Interosseous Artery Research Articles

FETAL ANATOMY OF THE ARTERIES OF THE DORSUM OF THE HAND

Fetal anatomy of the upper extremity in today’s understanding is a set of morphological methods for studying the structure and topography of the structures of its separate areas in human fetuses from the standpoint of the norm and taking into account the forms of individual anatomical variability. Also, in recent decades, microsurgical anatomy has gained intensive development, in particular the hand, which allows studying the structure and topography of small anatomical structures – blood vessels and nerves, muscle tendons, their layer-by-layer relationship in normal anatomical formation, and pathological deviations depending on the needs of microsurgery.The purpose of the study was to fi nd out the sources of blood supply, topography, and branching areas of the arteries of the back of the hand in human fetuses. The study was conducted on the preparations of 18 human fetuses aged from 4 to 10 months using macromicroscopic preparation, injection of arterial vessels, and morphometry.In human fetuses, the arteries of the back of the hand are arranged in two layers. The surface layer of the arterial vessels of the back of the hand, as a rule, is formed by the radial and anterior interosseous arteries, and (or), less often, by the ulnar or posterior interosseous arteries without the formation of arterial arches or nets. The deep layer of the arteries of the back of the hand mostly forms the back carpal arch and is inseparably connected both with the arteries of the superfi cial layer of the back of the hand and with the palmar arterial arches.The arteries of the deep layer of the back part of the hand are mostly (69.5 % of cases) represented by the back arterial arch: 1) radial-i nterosseous; 2) radial-i nterosseous-ulnar; 3) radial- ulnar; in 25 % of observations – with the posterior carpal arterial network. In 5.5 % of cases, the posterior carpal arch or posterior carpal mesh was absent, and duplication of the deep palmar arterial arch was found. Variability of the sources of formation, the degree of development, and the number of dorsal common digital arteries were revealed in human fetuses.Own dorsal digital arteries, except for the arteries of the thumb, as a rule, reach only the level of the middle phalanx of the fi ngers, and then they become thinner, or end in the periosteum or arterial arch-shaped anastomoses of the fi rst interphalangeal joint, or end in the palmar digital arteries, which provide blood supply to the back surface of the distal parts of the fi ngers of the brush.

Hand Reconstruction with Posterior Interosseous Flap. A Review

For the greatest functional outcome, hand reconstruction with soft tissue abnormalities requires an early, single-stage, well-vascularized cover. Since important tissues including tendons, bones, and joints are exposed, a full thickness graft is typically needed, and subsequent repair is frequently necessary. Reverse flow flaps in the posterior interosseous artery provide a flexible and dependable means of covering intricate soft tissue abnormalities in the hand in full thickness.

Reliability and Versatility of Posterior Interosseous Artery Flap in Reconstructing Hand Soft Tissue Defects

Reliability and Versatility of Posterior Interosseous Artery Flap in Reconstructing Hand Soft Tissue Defects

Free posterior interosseous artery perforator flap in the treatment of finger with skin and soft tissue defect

To explore clinical effects of repairing skin and soft tissue defect of finger with free posterior interosseous artery perforator flap. Totally 8 patients with finger skin and soft tissue defect repaired with free posterior interosseous artery perforator flap were treated from May 2021 to November 2022, including 7 males and 1 female aged from 24 to 54 years old, and soft tissue defect area ranged from 3.0 cm×1.5 cm to 5.0 cm×3.0 cm. The time from injury to flap repair ranged from 3 to 83 h. The free posterior interosseous artery perforator flap was applied to repair finger defect, the area of the flap ranged from 3.5 cm×2.0 cm to 5.2 cm×3.5 cm, the donor area of flap was sutured directly. The survival, appearance, texture and donor complications of the flap were observed after operation, and Dargan functional standard was used to evaluate clinical effect of finger function. All flap of 8 patients were survived, and followed up from 3 to 12 months. There was no obvious swelling, soft texture, obvious pigmentation, linear intaglio in donor area only, and without obvious complications were found. Among them, 3 patients'skin flaps were repaired for the defect of palm of the fingers, and sensory recovery was good, two-point discrimination ranged from 5 to 9 mm. According to Dargan functional evaluation, 3 patients excellent, and 5 good. Free posterior interosseous artery perforation branch flap could be used to repair the defect of finger. The thickness of flap is moderate, operation is convenient, appearance and texture of the operative flap are good, and the donor site is small without obvious complications, and obtain satisfactory clinical effect.

Reliability and Versatility of Posterior Interosseous Artery Flap in Reconstructing Hand Soft Tissue Defects

Reliability and Versatility of Posterior Interosseous Artery Flap in Reconstructing Hand Soft Tissue Defects

Comparison of lateral arm flap and posterior interosseous artery flap for soft tissue reconstruction of the elbow.

The study aimed to evaluate and compare the two different flap techniques used for the reconstruction of soft tissue defects in the elbow region: the lateral arm flap (LAA) and posterior interosseous artery (PIA) flap. The retrospective study included 12 patients who underwent surgical treatment for soft tissue defects between 2012-2018 at the clinic. The study evaluated demographic data, flap size, operating time, donor site, flap complications, number of perfora-tors, and functional and cosmetic outcomes. Results showed that patients who underwent PIA flap had significantly smaller defect size than those who underwent LAA flap (p<0.001). However, there were no significant differences between the two groups (p>0.05). Patients who received PIA flaps had significantly lower QuickDASH scores, indicating better functional results (p<0.05). The operating time was significantly shorter in the PIA group than in the LAA flap group (p<0.05). Additionally, the range of motion (ROM) of the elbow joint was significantly higher among the patients who received the PIA flap (p<0.05). The study concludes that both flap techniques are easy to apply depending on the surgeon's experience, have low complication risk, and provide similar functional and cosmetic results in similar defect sizes.

Variations in the Terminal Branches of Brachial Artery- A Cadaveric Cross-sectional Study

Introduction: Brachial Artery (BA) begins as a continuation of axillary artery at the distal border of teres major, it appears in the cubital fossa, where it ends at the level of the neck of radius by dividing into radial and ulnar arteries. Common Interosseous Artery (CIA) is the largest branch of Ulnar Artery (UA) and arises in the cubital fossa. The terminal branches of BA at elbow are clinically important since they are responsible for the arterial supply to the forearm and hand. These arteries may get damaged during fractures of the elbow. Aim: To know the variations in the terminal branches of the BA at elbow. Materials and Methods: The present cross-sectional cadaveric study was done on 40 upper limbs from embalmed adult human cadavers in the Department of Anatomy, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India, from August 2017 to August 2019. Dissection of BA in arm and cubital fossa was carried out according to Cunningham’s manual of practical anatomy. The distance of division of BA into radial and UA and distance of origin of CIA from Inter Epicondylar Line (IEL) of humerus were noted. Results: In present study, 20 right-side specimens and 20 left- side specimens were obtained. Among 20 cadavers used, 16 were male cadavers and four were female cadavers. The mean distance (D1) of normal division of BA into the Radial Artery (RA) and UA at elbow was 2.8 cm below the imaginary line joining the medial and IEL. The mean distance (D2) of normal origin of CIA was 6.8 cm below the imaginary line joining the medial and lateral epicondyles of the humerus (IEL). CIA arising from the UA was present in 37 specimens (92.5%) and in the rest three specimens Anterior Interosseous Artery (AIA) and Posterior Interosseous Artery (PIA) arose directly from the UA. Conclusion: The present study has found variations in site of division of terminal branches of the BA at elbow in three specimens

Reconstruction of fracture associated skin defects on olecranon with antegrade posterior interosseous artery flap

<br><b>Context:</b> The management of tissue defects of the olecranon after fractures of this region is challenging. Most cases require local or free flaps to obtain both soft-tissue reconstruction and wide range of motion of the elbow joint. <b>Aim:</b> The aim of this study is to describe the results of reconstruction of fracture-associated skin defects on the olecranon with posterior interosseous artery (PIA) flap. <b>Settings and Design:</b> We present our experience of using antegrade PIA flap for soft-tissue coverage of the olecranon region after fracture surgery. <b>Materials and Methods:</b> We retrospectively evaluated 11 cases who underwent reconstruction of the olecranon for soft tissue defect with PIA flap. We evaluated the extent of the soft-tissue defects and the harvested flaps, fracture fixation techniques, complications, patients' demographics, partial or total flap lost, number of perforators, time to reconstruction after injury, esthetic looking of reconstructed area, and donor site coverage. <b>Results:</b> The study included 11 patients (7 males and 4 females). The mean age was 35 years. The mean defect size was 15.4 cm². The mean flap size was 20 cm². Plates were used in six cases, tension band wiring in three cases, and external fixators in two cases for fracture fixation. Ten flaps survived completely. There was partial flap necrosis in one flap due to venous congestion. Infection, hematoma, and distal neurological deficits were not observed. Minimal morbidity occurred since the donor site was primarily closed in eight cases and skin graft in three cases. Good cosmetic outcome was achieved in all cases. We detected one perforator in one case, two perforators in five cases, three perforators in four cases, and four perforators in one case. <b>Conclusion:</b> Reconstruction with PIA flap is an effective, useful, and simple surgical technique for soft-tissue coverage on the olecranon region. The procedure involves a single step surgery, low donor site morbidity, and good cosmetic outcomes.<br>

An Anatomical Variation of Median Artery of Forearm and Palm: Cadaveric Study into its Origin and Course

Background The median artery (transitory artery) represents the forearm’s embryonic arterial axis. At 8th week of gestation retreats into a little canal that supplies the median nerve. Later, ulnar and radial arteries take its place. Adults may still have it in either a palmar or an antebrachial pattern. The persistent median arteries are a long, angular arterial that extends to the hand’s palmar surface. The median artery only partially recedes in the antebrachial type.&#x0D; Objective To identify the median artery distribution in the adult Nepalese population. Method Twenty-five adult human cadavers’ left and right upper limbs undergone to descriptive research. The persistent median artery was exposed according to the Cunningham’s Manual of Practical Anatomy.&#x0D; Result The forearm and hand arteries in each of the fifty upper limbs from the twenty-five formalin-embalmed human cadavers were studied. Among fifty upper limbs, persistent median arteries were found in six (twelve percent) of them. One percent of a cadaver’s right and left limbs had bilateral persisting median arteries (ante brachial). Persistent median artery of the ante brachial type that arises from the anterior interosseous artery in a right upper limb. Persistent median artery emerging from the posterior interosseous arteries were visible in one right upper limb.&#x0D; Conclusion The study showed persistent median artery of ante brachial type. The posterior interosseus artery is the source of the majority of antebrachial type. A median artery piercing the median nerve was discovered.

Soft tissue reconstruction of the thumb: Classification of defects and standardisation of treatment

The aim of this article is to share our experience of thumb defects based on the defect irrespective of the etiology of the defect and to work towards standardizing the treatment for thumb defects. This study was conducted at the Burns and plastic surgery center at Hayatabad Medical complex from 2018 to 2021. Thumb defects were divided into small (&lt; 3 cm), medium (4-8cm) and large defects (&gt; 9cm). Post-operatively, patients were evaluated for complications. The type of flaps were stratified for size and site of the soft tissue defects to generate a standardized algorithm for thumb soft tissue reconstruction. After scrutinizing the data, 35 patients qualified for the study, including 71.4% (25) males and 28.6% (10) females. The mean age was 31.17+15.8SD. Right thumb was affected in majority of the study population (57.1%). Majority of the study population was affected by machine injury and post-traumatic contractures, affecting 25.7% (n=9) and 22.9% (n=8) respectively. First web-space and injuries distal to IPJ of thumb were the most common areas affected, accounting for 28.6% (n=10) each. First dorsal metacarpal artery flap was the most common flap followed by retrograde posterior interosseous artery flap, observed in 11 (31.4%) and 6 (17.1%) cases. The most common complication observed in the study population was flap congestion (n=2, 5.7%) with a complete flap loss in 1 patient (2.9%) cases. Based on the cross tabulation of flaps against the size and location of defects, an algorithm was developed to help standardize reconstruction of thumb defects. Thumb reconstruction is critical in restoring hand function of the patient. The structured approach towards these defects make their assessment and reconstruction easy especially for novice surgeons. This algorithm can further be extended to include defects of the hand irrespective of etiology. Most of these defects can be covered with local easy to do flaps without the need for a microvascular reconstruction.

Evaluation of various options for resurfacing of soft-tissue defects of dorsum of hand and their outcome assessment

Background: Soft tissue defect of dorsum of hand is a difficult problem to deal with in reconstructive surgery. Various factors have to be considered for planning of the reconstruction. Aims and Objectives: To assess the overall incidence of soft tissue defect on dorsum of hand, evaluation of different options for coverage of soft tissue defect on dorsum of hand, assessment of outcome and complications (both primary and donor sites) of reconstructive procedures and coverage of defect with like for like tissue. Materials and Methods: We present our experience of resurfacing soft-tissue defects of dorsum of hand in 27 patients by split thickness skin grafting, local flaps, distant pedicled flaps, and free flaps. Results: Among total 27 patients, in whom resurfacing was done, distant pedicled flaps such as groin/abdominal flap were performed in 13 patients, regional flaps like posterior interosseous artery flap were done in seven patients, free flap like anterolateral thigh flap was the method in three patients, and skin grafting was used in two patients. Complications such as partial or complete flap necrosis were noted in one patient each of free and regional flap and none in distant pedicled flap. The operating time was relatively less in distant pedicled flaps. Conclusion: Skin grafting had limited use when underlying vital structures were exposed. Distant pedicled flaps such groin and abdominal flaps were very useful for resurfacing the defect especially in emergency situations. Regional and free flaps had limited indications.

Sequential posterior interosseous artery perforator flap for reconstruction of dorsal hand defects.

Dorsal hand defects accompanied by exposure of bones and tendons remain a huge challenge for plastic surgeons. The pedicled perforator flaps have unique advantages in resurfacing the defects. This study aimed to investigate the clinical efficacy of the sequential posterior interosseous artery perforator flap for repairing dorsal hand defects. This study was composed of an anatomical study and clinical application. Anatomically, 30 adult upper limb specimens injected with red latex were dissected, the perforators from the branches of the posterior interosseous artery were observed in the dorsal forearm, and the sequential flap based on them was designed based on the anatomical characteristics. Clinically, nine cases of soft tissue defects on the dorsum of the hand were treated by this flap. Anatomically, the posterior interosseous artery divided into an ascending branch and a descending branch, and the descending branch traveled 1.0 ± 0.3cm down to divide into the ulnar and radial terminal branches. The ulnar terminal branch presented constantly, and the radial terminal branch had an occurrence rate of 93.33%. Clinically, all flaps survived completely and possessed a soft texture and satisfactory appearance, as well as a nonbloated pedicle, and the donor region had a natural color and appearance with only a linear scar left behind. The sequential posterior interosseous artery perforator flap could become a useful option for repairing dorsal hand defects, as it has the advantages of being easy to perform without sacrificing the main vessels and avoiding donor area skin grafting.

Versatility and reliability of reverse posterior interosseous artery flap for coverage of soft tissue defects of hand and wrist.

Objective: To evaluate reverse PIA flap in reconstruction of various types of soft tissue defects of the hand in terms of reliability, flap survival, total duration of hospital stay, patient’s satisfaction and duration of return to work Study Design: Case Series study. Setting: Jinnah Burn and Reconstructive Surgery Center, Lahore. Period: January 2018 to July 2020. Material &amp; Methods: Twenty three posterior interosseous artery flaps were used for coverage in patients who had soft tissue defects over hand dorsum, wrist and first web space. Both sexes were included with age group ranging between 15 to 60 years. Results: Twenty two flaps, out of total 23 survived completely. In one patient, there was partial flap necrosis for which skin grafting was done. Donor sites were successfully covered with skin grafts. All patients went on to resume their work within a month or two and were quite satisfied with aesthetic outcome. Conclusion: A well planned reverse PIA flap is not only a safe, versatile and reliable option for coverage of hand defects but also entire has the benefit of a shorter hospital stay, allowing early return of patient to work and superior aesthetic outcome.

"Safe dissection parameters of the anconeus rotational flap for soft tissue coverage at the elbow".

The anconeus is a small muscle located on the posterior elbow originating on the lateral epicondyle and inserting onto the proximal-lateral ulna that functions as an elbow extensor as well as dynamic stabilizer. The blood supply is tri-fold: medial/middle collateral artery (MCA), recurrent posterior interosseous artery (RPIA), and less commonly found, the posterior branch of the radial collateral artery. The anconeus has become a popular option for local soft tissue coverage about the elbow (distal triceps, olecranon, proximal forearm). The average defect size for consideration of local anconeus flap coverage is 5-7cm2. The aim of the study was to determine safe dissection parameters of the anconeus as well as map arterial pedicles to achieve successful local harvest of the muscle without devascularization. 8 fresh frozen cadaveric arms (all male, average age 63 years - 4 left arms, 4 right arms) from scapula to fingertip were obtained. First, the radial, ulnar and axillary arteries were dissected and isolated. The radial and ulnar arteries were transected. 100cc normal saline was injected through the axillary artery, sequentially clamping the radial followed by the ulnar artery so that adequate flow could be seen through all vessels. 100cc mixture of Biodür and hardener (10:1) was mixed and injected into the axillary artery. We first allowed free flow through both the ulnar and radial vessels followed by clamping of these vessels. This allowed the pressure to build up and fill the smaller vessels in the arms. After injection, the axillary artery was then clamped and the specimens were left to harden for 24-48 h. After hardening, dissection was performed by making a curvilinear incision centred over the lateral epicondyle. The anconeus was identified and the interval between the anconeus and ECU was then confirmed. Measurements of the anconeus muscle were taken. Blunt dissection was carried between anconeus and ECU until the RPIA was identified and protected. We isolated the MCA by dissecting proximally. This was found to run with the nerve to the anconeus. Once this vessel had been protected, the muscle reflected from distal to proximal staying along its ulnar border. The branches of the RPIA were ligated and the dissection was continued proximally. Measurements of the distances of the RPIA, MCA were taken. The average distance of olecranon to muscle tip was 95.0mm. The average distance of lateral epicondyle (LE) to muscle tip was 90.8mm. The average distance of LE to olecranon was 49.8mm. The average location of the RPIA was 63.mm when measuring LE to vessel, 68.3mm when measuring olecranon to vessel, 18.3mm when measuring RPIA to muscle tip. The average RPIA diameter was 1.1mm and length was 36.4mm from the initial branching of the posterior interosseous artery. The average MCA diameter was 0.7mm. The posterior branch of the radial collateral artery was only found in 3/8 specimens. The RPIA and MCA were constant in all specimens. Dissection was safely carried to the border of the LE and olecranon without disruption of the MCA. Our conclusions determined that if dissection of the anconeus is undertaken, the RPIA remains constant between the interval of the ECU as well as anconeus at an average distance of 18.3mm from the tip of the muscle measuring proximally; moreover, the MCA was constant in all specimens found directly between the LE and olecranon always running with the nerve to the anconeus. When dissecting and mobilizing to ensure preservation of the MCA, dissection should be taken from distal to proximal as well as dissecting along the ulnar border of the anconeus. Proximal dissection can be taken as proximal as the border of the LE and olecranon as that did not disrupt MCA blood supply.

ALTERING THE MARKING OF THE REVERSE POSTERIOR INTEROSSEOUS ARTERY FLAP

BackgroundFull-thickness defects on the dorsum of the hand requires thin, soft, and pliable skin for which there are limited locoregional flaps. The reverse posterior interosseous artery (PIA) flap based on the communicating artery fulfills all above requirements and can reach upto the fingers. However, there has been discrepancy in the surface marking of the flap and the anatomical position of the vessel pedicle. We share our alteration with the marking and ease of harvesting this flap.Method and materialThis is a prospective study conducted at a private teaching hospital in Karachi, over a period of 2 years from November 2017 to December 2019. After taking consent and ensuring confidentiality of all patients who had PIA flap reconstruction, we collected patient's demographic details, mode of injury, and flap surface area. We altered the described skin marking and took measures to prevent venous congestion and noted the outcomes in term of flap congestion and flap loss.ResultsTwenty-eight patients with a mode age of 32 years were operated during this period. The majority (64.2%) had a motor vehicle accident and machine injuries. The mean surface area of flaps was 6 × 10 cm2, and 11 (39.2%) flaps had venous supercharging. All patients had a 10-20° wrist extension splint for 2 weeks. The mean follow-up of the patients was 14 ± 5 days, and 6 (21.4%) flaps developed a minimal marginal flap loss, which was managed conservatively.ConclusionBy minimally altering our surface marking, we experienced a easy and quick harvesting of this flap. However, one has to be vigilant and take all described precautions for venous congestion.

Use of the Antegrade Posterior Interosseous Artery Flap for Coverage of Complex Elbow Wounds.

One of the most versatile soft-tissue flaps available for elbow coverage that is reliable, quick, and easy to perform, with minimal donor defect and without the sacrifice of a major blood vessel, is the antegrade posterior interosseous artery flap. A large amount of vascularized fascia can be dissected with the flap, and it can be useful in lining the elbow joint or any exposed implant(s). After flap harvest, the donor site is often amenable to primary closure or requires a simple skin graft for closure. This article explains the technique for harvesting an antegrade posterior interosseous artery flap and describes 10 cases in which the flap was used for complex soft-tissue defects of the elbow not amenable to local wound care or skin grafting.

Technical Refinements in Posterior Interosseous Artery flap

Technical Refinements in Posterior Interosseous Artery flap

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

Reverse-flow posterior interosseous artery (rPIA) flap is an excellent tool for restoration of defects in the hand and upper extremity, sparing the main arteries to the hand. Its reliability has been well established. Fifty-one cases of rPIA flap involving 49 patients were retrospectively reviewed. The inclusion criteria were age, sex, etiology, size and location of the defect, flap size, number of perforators included, pedicle length, flap inset, donor site coverage, complications, and ancillary procedures. This study included 44 men and 5 women, ranging in age between 10 and 73 years. The subjects had soft tissue defects of the hand and upper extremity mainly due to traumatic injuries, including scar contractures of the first web space in 18 cases, thumb amputations in 6 cases, and congenital defects in 1 case. Among the 51 rPIA flap elevations, 3 cases involved flap failure due to the absence of proper pedicle. A fasciocutaneous pattern was observed in 45 cases and a myocutaneous pattern in 3 cases. In 5 cases of unplantable thumb amputations, the rPIA flap was performed for arterial inflow to the secondary toe-to-thumb transfer. Venous congestion of varying degrees was noted in 7 cases involving partial necrosis in 2 cases. During the mean 17 months of follow-up, patients were generally satisfied with the final outcomes. The rPIA flap can be used not only for soft tissue coverage of the hand and upper extremity but also as a recipient arterial pedicle for a secondary toe-to thumb transfer.

The use of the posterior interosseous artery flap and anterolateral thigh flap for post-traumatic soft tissue reconstruction of the hand.

The purpose of this study was to examine the differences between the use of a posterior interosseous artery (PIA) flap and an anterolateral thigh (ALT) flap for post-traumatic, medium-sized soft tissue reconstruction of the hand based on flap characteristics, postoperative complications, and aesthetic outcomes.From October, 2010 to March, 2016, 62 patients undergoing soft tissue reconstruction of the hand with 30 PIA flaps and 32 ALT flaps were included in this study. The 62 patients were divided into the PIA flap group and the ALT flap group. The differences between the 2 groups were analyzed.The 62 patients included 52 males and 10 females, and the mean age at the time of surgery was 41 years. The flap failure rate was 13.3% (4/30) in the PIA flap group and 9.4% (3/32) in the ALT flap group. No significant differences in flap failure rate, recipient site complication rate, or donor site complication rate were observed between the 2 groups. However, the operative time (136 min vs 229 min) and aesthetic outcomes (flap bulk swelling, 0 cases vs 31 cases) were statistically significantly different.Both the pedicled PIA flap and the free ALT flap were comparable for the reconstruction of post-traumatic, medium-sized soft tissue defects of the hand according to the evaluated outcomes of postoperative complications. Based on the surgical characteristics of the flap and the evaluation of aesthetic outcomes, the pedicled PIA flap was significantly superior to the free ALT flap.

An extended distally based reverse posterior interosseous artery flap reconstruction for the thumb and distal defects of the fingers.

The reverse posterior interosseous artery flap is useful for covering hand defects. However, its major drawback is the short pedicle that limits the reach of the flap up to the metacarpophalangeal level. The authors performed a new modification extending the distal reach of the flap by including the recurrent branch of the posterior interosseous artery and they aimed to present the results of reconstruction with this technique. Seven patients with a mean age of 35.2 years (range 17-64 years) underwent extended RPIAF surgery. Six patients were admitted to the emergency department with isolated hand trauma. One patient was present in elective settings with chronic osteomyelitis and skin loss of the thumb related to previous trauma. The defects were located on the distal metacarpophalangeal level (thumb and other fingers). PIA perforators and the recurrent branch were included into the pedicle (Type A) in five cases, whereas the flap was harvested based solely on the recurrent branch (Type B) in two cases. The type B flaps had longer pedicle lengths due to discarding the forearm skin. The donor sites were covered with skin grafts in six patients. The average size of the extended RPIAF was 3 × 3.5 cm to 10 × 6 cm (mean 8.28 × 4.14 cm). All of the flaps completely survived, and no complications were encountered during the postoperative period. Functional recovery of the operated hands were observed during the follow up period 13.5 months (8-24 months). Both the patient and our satisfactory levels were high and all of the patients returned to their works. Quick DASH score was used in the final functional evaluation retrospectively. Due to the pandemic, the evaluation could be made with a telephone. Two patients could not be reached in the evaluation. The mean quick DASH score of five patients was 28.64. The extended RPIAF is a reliable choice in distally located thumb and finger defects if the recurrent branch of the posterior interosseous artery is included in the pedicle.