Reverse Posterior Interosseous Flap; Useful but Problematic Flap

Objective: To highlight the problems associated with harvesting and insetting of reverse Posterior Interosseous Artery (PIA) flap and their solutions. Study Design: Descriptive case series. Place and Duration of Study: The study was conducted at Combined Military Hospital Rawalpindi from January 2013 to July 2015. Material and Methods: Thirty one patients of both sexes with hand defects secondary to trauma, burn or tumor excision who underwent coverage with reverse PIA flap were included in the study. Patients were operated and reviewed by the same team. Age, sex and complications were recorded and data was evaluated. Results: Major complications were found out to be venous congestion as 5 (16.1%) of our flaps developed venous congestion and had to be replaced at the donor site. Four (12.9%) flaps developed partial necrosis. These flaps were debrided and reinsetting was done. One (3.22%) flap developed complete necrosis. Eight flaps were delayed on suspicion of congestion preoperatively. In all delayed flaps the recovery was uneventful and smooth. Conclusion: PIA flap is a useful option for coverage of hand defects. The major issue is flap congestion which can be improved by delaying the flap and it helps in improving the flap survival.