Venous super-drained posterior interosseous artery flap for dorsal hand defects.

Background Posterior interosseous artery flap PIAF is one of the most preferred reconstructive options for upper extremity defects. As a reverse flap, venous congestion is always a threatening factor. In this report authors aimed to present their experience with venous super-drained posterior interosseous artery flap VS-PIAF. Methods Between January 2013 to September 17, 2017 patients were treated with VS-PIAF. Tumor excision, trauma, traffic accident, burn contracture release, and industrial injuries were the causes of defects. Defects were located on the dorsum of the hand, first web space, ulnar and radial side of the hand, and the palm. All the defects were reconstructed with a VS-PIAF, which a distal superficial end-to-end venous anastomosis was added to overcome venous congestion problems. Results The flap sizes were between 5 x 7 cm and 8 x 12 cm. All the flaps have survived completely without any early or late complications. No venous problems were seen. The donor areas were healed uneventfully. The mean follow-up time was 15.3 months. The results of reconstructions were satisfactory, no functional restrictions was seen. Conclusion The major drawback of PIAF is venous congestion problems that can be manageable with adding a distal superficial end-to-end venous anastomose. VS-PIAF is a robust, much safer and easy-to-learn reconstructive method for upper extremity defects.