title: Posterior interosseous artery perforator-free flap: treating intermediate-size hand and foot defects.
abstract: BACKGROUND
  Ambiguous defects on the hand and foot, especially on the fingers and toes, are still challenging to treat despite achievements in reconstruction.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the use of the posterior interosseous artery perforator flap for resurfacing intermediate-sized defects and provide adequate coverage over tendons and bones.
  
  
  METHODS
  Between October 2008 and March 2013, a total of 19 patients with soft-tissue defects on the hand or foot were treated. Flap elevation, anatomy, and clinical progress were evaluated.
  
  
  RESULTS
  All flaps survived and covered the defects, which ranged in area from 12 to 45 cm(2). The freestyle approach was used to harvest the flaps. The average length of the pedicle was 2.5 cm, and the pedicle was harvested without affecting the source vessel. The average diameter of the artery was 0.8 mm, and the average thickness of the flap was 3.5 mm. Anastomosis was performed either end-to-end on the perforator, or end-to-side on deep vessels. No subsequent thinning or surgical flap correction was necessary. Ambulation was allowed at 3 days postsurgery. The donor site was closed primarily to leave an acceptable donor site.
  
  
  CONCLUSIONS
  A posterior interosseous artery perforator-free flap is a suitable choice for intermediate-size defects that are too large to cover using a local flap or too small for a first-line perforator flap. Up to 45 cm(2) of adequate coverage can be provided using a thin posterior interosseous artery perforator-free flap that does not require additional debulking. The disadvantages of a short pedicle can be overcome using perforator-to-perforator supermicrosurgery.
authors.affiliation: Department of Plastic Surgery, Ulsan University Hospital, University of Ulsan, Ulsan, South Korea.
authors.forename: Chi Sun
authors.initials: CS
authors.lastname: Yoon
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Ulsan, South Korea.
authors.forename: Hyung Joo
authors.initials: HJ
authors.lastname: Noh
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Ulsan, South Korea.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Malzone
authors.affiliation: Department of Plastic Surgery, Ewha Womans University Hospital, Seoul, South Korea.
authors.forename: Hyun Suk
authors.initials: HS
authors.lastname: Suh
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Ulsan, South Korea.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Choi
authors.affiliation: Department of Plastic Surgery, Asan Medical Center, University of Ulsan, Ulsan, South Korea. Electronic address: joonphong@amc.seoul.kr.
authors.forename: Joon Pio
authors.initials: JP
authors.lastname: Hong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001158:Arteries / Q000637:transplantation*; D002648:Child; D015331:Cohort Studies; D017719:Diabetic Foot / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D018409:Foot Injuries / Q000601:surgery; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006084:Graft Rejection; D006085:Graft Survival; D006230:Hand Injuries / Q000601:surgery; D006801:Humans; D008297:Male; D008545:Melanoma / Q000601:surgery; D008875:Middle Aged; D061525:Perforator Flap / Q000098:blood supply* / Q000637:transplantation; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000601:surgery; D017695:Soft Tissue Injuries / Q000601:surgery*; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
keywords: Hand and foot reconstruction; Perforator flap; Posterior interosseous artery perforator flap; Small soft-tissue defect; Supermicrosurgery