Distally based posterior interosseous artery (PIA) flap is a very useful flap for defects on hand. Dissection of flap is not easy unless certain anatomical landmarks are identified and preserved throughout the dissection. We suggest here few refinements which not only improve reliability of flap but also may reduce operative time.

We start with an incision in the distal forearm on ulnar border of the flap. This ensures rapid and accurate identification of the septum. Similarly, we describe other modifications such as design of skin paddle, identification of communicating branch, transfer of flap among others.

Keywords: Hand defects, distally based posterior interosseous artery flap, refinements

1. Lamberty BG, Cormack GC. Fasciocut-aneous flaps. Clin Plast Surg 1990; 17:713-26.
2. Pauchot J1, Lepage D, Leclerc G, Flamans B, Obert L, Tropet Y. Posterior interosseous free flap because of absence of posterior interosseous pedicle. A report of an individualised salvage procedure and of an exceptional anatomical variation. Review of the literature. Ann Chir Plast Esthet. 2010 Feb; 55(1):56-60.
3. Acharya AM, Bhat AK, Bhaskaran K, The Reverse Posterior Interosseous Flap Technical considerations in raising an easier and more reliable flap. J Hand Surg Am 2012; 37:575–82.
4. Sun C, Wang YL, Ding ZH, Liu P, Qin XZ, Lee HL, Jin AM. Anatomical basis of a proximal fasciocutaneous extension of the distal-based posterior interosseous flap that allows exclusion of the proximal posterior interosseous artery. J Plast Reconstr Aesthet Surg. 2015 Jan;68(1):17-25
5. Penteado CV, Masquelet AC, Chevrel JP. The anatomic basis of the fascio-cutaneous flap of the posterior interosseous artery. Surg Radiol Anat. 1986; 8:209–215.
6. Balakrishnan G, Kumar BS, Hussain SA. Reverse-flow posterior interosseous artery flap revisited. Plast Reconstr Surg 2003; 111(7):2364–9.
7. Zancolli EA, Angrigiani C. Posterior Interosseous island forearm flap. J Hand Surg Br 1988; 13: 130-5.

8. Akdağ O, Yıldıran G, Sütçü M, Karameşe M. Posterior interosseous flap versus reverse adipofascial radial forearm flap for soft tissue reconstruction of dorsal hand defects. Ulus Travma Acil Cerrahi Derg 2018;24:43-8
9. Muhammad Naveed Shahzad, Naheed Ahmed, Khalid Hussain Qureshi. Reverse flow posterior interosseous flap: Experience with 53 flaps at Nishtar Hospital, Multan. Journal of Pakistan Medical Association 2012; 62(9):950-4
10. Reyad KA, Shaker AA, Elbarbary AS, Sayed MA, Elghareeb MA. The Number of Perforators Included in Reversed Flow Posterior Interosseous Artery Flap: Does It Affect the Incidence of Venous Congestion? Plast Recontsr Surg Glob Open 2016;22;4(12):e1162
11. Puri V, Mahendru S, Rana R. Posterior interosseous artery flap, fasciosubcu-taneous pedicle technique: a study of 25 cases. J Plast Reconstr Aesth Surg 2007; 60: 1331-7.

Dr Rohit Munot

Assistant Professor, Dept of Plastic Surgery, LTMG Hospital Sion, Mumbai-22, India

Ph No: +919860122763/ 02224043141, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.