Reconstruction of the Hand Soft Tissue Defects with the Free Proximal Posterior Interosseous Artery Perforator Flaps

Introduction: To investigate the applied anatomy of the proximal posterior interrosseous artery perforator flap (PIAP) and report the clinical results of repairing the soft tissue defects in hands．

Methodology and Material: From September 2007 to October 2013, 35 cases of soft tissue defects over the hand were repaired by the proximal posterior interosseous artery perforator flap (PIAP). The size of the flaps ranged from 2.0cm×1.5cm to 7cm×5cm． The longest length of these flaps was 9cm. To prevent the flap congestion, 16 flaps were dissected with one additional superficial vein to anastomose with the superficial vein at the recipient sites. The muscularfascia of the proximal dorsal forearm were used to reconstruct the extensor tendon defect in 9 patients. Two isolated flap was raised from the same donor site to resurface different finger defect in 5 patients.

Results: 23 flaps survived completely．Bubbles and violet color happened in 9 flaps which survived finally after partial suture removal．Flap necrosis occurred in 3 flaps．2 patients couldn’t extend the long finger after surgery, and they recovered one month later with conservative management. The clinical results were satisfactory after 6-25 months of following-up， and the scars at the donor sites were not obvious.

Conclusions: The free proximal PIAP flaps have constant， reliable blood supply， and good texture． It is a good option for repairing soft-tissue defects in the hands&#65294