The Distally Based Posterior Interosseous Artery Flap for Hand and Wrist Reconstruction: A Clinical Case Series and Technical Considerations

Background: Soft-tissue defects of the hand and wrist represent a reconstructive challenge due to the need for thin, pliable coverage that preserves function and aesthetics. The distally based posterior interosseous artery (PIA) flap offers a reliable regional option without sacrificing a major arterial axis. Objective: To evaluate clinical outcomes, complications, and technical refinements associated with the use of the distally based posterior interosseous artery flap for reconstruction of hand and wrist defects. Methods: A retrospective review was conducted on patients who underwent reconstruction with a distally based PIA flap for traumatic or post-surgical defects of the hand and wrist. Demographic data, defect characteristics, flap dimensions, survival rates, and postoperative complications were analyzed. Results: The flap demonstrated a high rate of complete survival, with partial distal necrosis occurring in a minority of early cases. Mild venous congestion was observed initially but did not compromise final outcomes. Incorporation of additional subcutaneous tissue and superficial venous structures appeared to reduce venous complications. Donor-site morbidity was low, although split-thickness skin grafting occasionally resulted in aesthetic dissatisfaction. Conclusions: The distally based posterior interosseous artery flap is a dependable and versatile option for coverage of selected hand and wrist defects. Proper preoperative planning and meticulous dissection are essential to minimize complications, particularly venous congestion and issues related to anatomical variation.