Arch Hand Microsurg.  2018 Sep;23(3):195-205. 10.12790/ahm.2018.23.3.195.

Revisiting the Posterior Interosseous Artery Flap

• Eo SR
• Hwang SH
• Hong KY
• Lim SA
• Lee GJ

• KMID: 2419455
• DOI: http://doi.org/10.12790/ahm.2018.23.3.195

Abstract

The posterior interosseous artery (PIA) flap is one of the options for hand and upper extremity reconstruction. It does not sacrifice the main arteries of the hand, the radial and ulnar arteries and could be used even when either artery was damaged. The PIA is a branch of the common interosseous artery, which is about 1 cm in distance from the ulnar artery, and runs down longitudinally in the intermuscular septum between the extensor carpi ulnaris and extensor digiti minimi. PIA appears to be relatively constant in position, and pro a reliable blood supply in the posterior aspect of the forearm. The PIA flap is reliable in its designs, even to making it possible to close the donor site primarily. It provides not only a thin, pliable coverage of the hand and upper extremity, but also a neurosensory flap. Technically, the dissection of the PIA pedicle along its course needs a high learning curve, because it might present the risk of venous congestion, ischemic flap necrosis, and injury to the PIN. Although the flap dissection seems to be difficult, it still offers increased versatility in reconstructions of the hand, foot, and upper extremity.

Keyword

Reconstructive surgical procedures; Hand; Posterior interosseous artery

MeSH Terms

Arteries*
Foot
Forearm
Hand
Humans
Hyperemia
Learning Curve
Necrosis
Reconstructive Surgical Procedures
Tissue Donors
Ulnar Artery
Upper Extremity

Figure

• 

  Fig. 1 The schema of reverse PIA flap. PIA: posterior interosseous artery, EDM: extensor digit minimi, ECU: extensor carpi ulnaris, AIA: anterior interosseous artery, IRA: interosseous recurrent artery.

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  Fig. 2 A 49-year-old male patient had an amputation at the mid-shaft level of the 1st metacarpal bone. Four months later, the rPIA flap provided an additional base for a toe-to- thumb transfer. (A) Preoperative view. (B) Flap elevation. (C) Coverage of the remnant thumb with rPIA flap. (D) Postoperative view. rPIA: retrograde posterior interosseous artery.

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  Fig. 3 A 12-year-old boy showed an adduction contracture of the 1st web space of the left hand. (A) The contracture was released. (B) rPIA flap was elevated. (C, D) Postoperative view. rPIA: retrograde posterior interosseous artery.

• 

  Fig. 4 A 53-year-old male patient had contact burn injury on the palm and 1st web space of the right hand. (A) Preoperative view after the debridment. (B) rPIA flap was elevated with long skin paddle. (C, D) Postoperative view. rPIA: retrograde posterior interosseous artery.

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