Posterior interosseous artery perforator propeller flap for the repair of wrist and hand dorsal wounds

TL;DR

This study shows that the posterior interosseous artery perforator flap is effective for repairing wounds on the back of the wrist and hand.

Contribution

The study introduces the PIA perforator propeller flap as a reliable and minimally invasive option for dorsal hand and wrist wound repair.

Findings

11 out of 12 flaps survived completely with high patient satisfaction (91.67%).

DASH scores improved post-surgery, indicating better hand function.

Minimal donor-site trauma and favorable aesthetic outcomes were observed.

Abstract

This study aimed to evaluate the clinical efficacy of the posterior interosseous artery (PIA) perforator propeller flap for the repair of dorsal wrist and hand wounds.

From October 2018 to October 2022, 12 patients with dorsal defects of the wrist (n = 5) or hand (n = 7) underwent repair using the PIA perforator flap. The surgical technique involved preoperative Doppler ultrasound localization of perforators, flap design centered on the selected perforator, and rotation of the flap up to 180° to cover the defect. Surgical outcomes were assessed based on flap survival, complications, and changes in preoperative/postoperative visual analog scale scores and disability of the arm, shoulder, and hand (DASH) scores.

Twelve cases of skin flaps were successfully harvested, and the donor sites were directly sutured. Postoperatively, 11 flaps survived completely, while one case developed a wound infection that resolved with debridement and dressing changes. Patients were followed for 6–18 months (mean 12 months). Flap texture and appearance were satisfactory, with no significant swelling observed. Patient satisfaction reached 91.67%. At the final follow-up, DASH scores ranged from 2 to 15, with a mean of 9.2. Mild scar hyperplasia was observed at the donor site in two cases and at the flap margin in one case.

For repairing soft tissue defects of the dorsal wrist, the posterior interosseous artery perforator flap provides a valuable and reliable clinical option due to its consistent vascular supply, preservation of major vessels, minimal surgical complexity, favorable aesthetic and tactile qualities, minimal donor-site trauma, and high flap survival rate.

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