Objectives: We evaluated vascular problems in patients who were planned to receive posterior interosseous artery (PIA) flap for soft tissue defects in the dorsal hand, thumb, and the first web.
Methods: The study included 25 male patients (mean age 27 years; range 12 to 54 years) in whom reconstruction was planned with the use of the reverse PIA flap. The defects were in the following localizations: the dorsal hand (n=15), the first web (n=5), hypothenar region (n=3), and the palmar aspect of the wrist (n=2). The frequency of anatomic variations and complications were evaluated.
Results: The use of the PIA flap was cancelled in one patient (4%) due to an anatomic variation of the PIA in the forearm. The vascular pedicle of the flap was removed because of insufficient arterial perfusion due to the absence of distal carpal anastomosis and the donor tissue was used as a free flap in two patients (8.3%). The remaining 22 patients who received pedicled flaps were followed-up for a mean of 3.2 months (range 1.5 to 6.5 months), during which six patients (27.3%) developed venous insufficiency. A superficial vein anastomosis was performed in five patients within the first 24 hours, which resulted in complete improvement. One patient was not available for venous anastomosis and developed flap necrosis. The occurrence of venous insufficiency was not correlated with the timing of flap surgery, the size of the flap, and the placement of the flap pedicle (p>0.05).
Conclusion: The use of the reverse PIA flap is appropriate for soft tissue defects in the dorsal hand, thumb, and the first web. However, the frequency of anatomic variations and vascular complications is higher compared to other reverse pedicled flaps.