title: Distally based subcutaneous veins for venous insufficiency of the reverse posterior interosseous artery flap.
abstract: BACKGROUND
  The reverse posterior interosseous artery flap (PIAF) provides soft, thin, and pliable tissue for upper extremity reconstruction without sacrificing any major arteries of the hand. The authors performed a new technique that included one extra distally based subcutaneous vein within the pedicle to diminish venous insufficiency and they aimed to present the results of reconstruction with this technique.
  
  
  METHODS
  Twelve patients with a mean age of 30 years (range 5-52 years) underwent reverse PIAF surgery. The defects were located on the hand and wrist, with a mean area of 57.8 cm2(range 20-99 cm2). After the skin between the distal edge and the pivot point of the flap was elevated, the most reliable subcutaneous vein was chosen, chased, and included within the flap.
  
  
  RESULTS
  The average size of the PIAF was 6 × 5 cm to 12 × 9 cm (mean area: 64.4 cm2) and the median follow-up time was 13 months (range 4-16 months). The mean quick Disabilities of the Arm, Shoulder and Hand (DASH) score was 21.4, indicating a low degree of disability. Of the 12 patients, ten were very satisfied and two were satisfied with the result of the reconstruction. All but one flap survived completely. One flap was nearly totally lost due to arterial insufficiency after hemodialysis. We observed no venous congestion or insufficiency in the patients.
  
  
  CONCLUSIONS
  Subcutaneous veins may be reliable and useful for overcoming major drawbacks associated with reverse flow posterior interosseous artery flap and for diminishing flap loss due to venous insufficiency. © 2016 Wiley Periodicals, Inc. Microsurgery 36:384-390, 2016.
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Dicle University, Medical Faculty, Diyarbakır, Turkey.
authors.forename: Burhan
authors.initials: B
authors.lastname: Özalp
authors.affiliation: Department of Plastic, Reconstructive and Aesthetic Surgery, Dicle University, Medical Faculty, Diyarbakır, Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Elbey
authors.affiliation: Hand Surgery Division, Department of Plastic, Reconstructive and Aesthetic Surgery, İstanbul University, İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Atakan
authors.initials: A
authors.lastname: Aydin
authors.affiliation: Hand Surgery Division, Department of Plastic, Reconstructive and Aesthetic Surgery, İstanbul University, İstanbul Medical Faculty, İstanbul, Turkey.
authors.forename: Türker
authors.initials: T
authors.lastname: Özkan