title: Free multilobed posterior interosseous artery perforator flap for multi-finger skin defect reconstruction.
abstract: BACKGROUND
  The posterior interosseous artery (PIA) perforator flap can be used for reconstruction of soft-tissue defects of fingers. Based on the multiple perforators from the posterior interosseous artery, we describe a technique to reconstruct the multi-finger defect in the use of the free multilobed PIA perforator flap.
  
  
  METHODS
  PIA perforators from different areas of the forearm were used to design a free multilobed skin paddle for multi-finger skin defect reconstruction. Each paddle without the deep fascia had separate perforators. To increase the perforator pedicle length, the courses of the PIA perforators were dissected from the superficial layer of the deep fascia to the subcutaneous layer.
  
  
  RESULTS
  The flap was raised as a unilateral free bilobed PIA perforator flap in 10 cases of two-finger defects, a free trilobed PIA perforator flap in two cases of three-finger defects, and a bilateral free bilobed PIA perforator flap in one case of four-finger defects. The average effective vascular pedicle length and trunk pedicle length were 8.3 and 3.1 cm, respectively, for the bilobed flap, and 6.3 and 4.0 cm, respectively, for the trilobed flap. All flaps survived except one paddle with tip necrosis. At 10.8 months (range, 4-27 months) after surgery, 10 cases showed satisfactory cosmetic appearance, while the fingers were bulky in the remaining three cases. The average score of static two-point discrimination in 10 innervated paddles was 12.9 mm. The remaining 20 paddles recovered only protective sensation. The average total active motion (TAM) of each finger was 164° before surgery and 187° at the latest follow-up.
  
  
  CONCLUSIONS
  Free multilobed PIA perforator flap is a good candidate for reconstruction of multi-finger skin defect.
  
  
  METHODS
  Therapeutic, Ⅳ.
authors.affiliation: Department of Hand Surgery, Affiliated Nanhua Hospital, University of South China, Hengyang, Hunan, 421002, People's Republic of China.
authors.forename: Kuang-Wen
authors.initials: KW
authors.lastname: Li
authors.affiliation: Department of Hand Surgery, Affiliated Nanhua Hospital, University of South China, Hengyang, Hunan, 421002, People's Republic of China. Electronic address: 839968644@qq.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.affiliation: Department of Hand Surgery, Affiliated Nanhua Hospital, University of South China, Hengyang, Hunan, 421002, People's Republic of China.
authors.forename: Ming-Jiang
authors.initials: MJ
authors.lastname: Liu
authors.affiliation: Department of Hand Surgery, Affiliated Nanhua Hospital, University of South China, Hengyang, Hunan, 421002, People's Republic of China.
authors.forename: Song-Lin
authors.initials: SL
authors.lastname: Xie
authors.affiliation: Department of Hand Surgery, Affiliated Nanhua Hospital, University of South China, Hengyang, Hunan, 421002, People's Republic of China.
authors.forename: Chang-Xiong
authors.initials: CX
authors.lastname: Liu
mesh_terms: D000328:Adult; D001158:Arteries / Q000637:transplantation; D015331:Cohort Studies; D005260:Female; D005383:Finger Injuries / Q000175:diagnosis / Q000601:surgery*; D005385:Fingers / Q000098:blood supply; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D061525:Perforator Flap / Q000098:blood supply*; D019651:Plastic Surgery Procedures / Q000379:methods*; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012867:Skin / Q000293:injuries*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology
keywords: Finger; Microsurgery; Multilobed flap; Posterior interosseous artery (PIA)