Addressing Soft Tissue Defects of Hand and Forearm Using Posterior Interosseous Artery Flap: An Observational Study

Abstract: Background: Covering large wounds in a stable, long-lasting, and aesthetically pleasing manner is the primary task for a hand surgeon. Because the posterior interosseous artery (PIA) flap produces thin, malleable skin, it is an excellent tissue for covering hand deformities. Objective: To determine frequency of successful flap survival based on PIA flap in patients with soft tissue injuries of the dorsum of the forearm and hand. Materials and Methods: The prospective observational study was conducted at Plastic & Reconstructive Surgery Department of Dr. KM Ruth Pfau Civil Hospital in Karachi, Pakistan. After obtaining approval from the institutional review board's official, (IRB-3378/DUHS/clearance/2024/24), the study took place from 1st May to 30th October of 2024.The follow-up was done two weeks after their surgery. Clinical examination was used to monitor the flaps including assessment of flap color, skin turgor and absence of venous congestion. If patients were found normal and recovering during the follow-up, the flaps were marked as successful. Result: A total of 32 patients were studied with average age of 31.4 ± 9.9 years. Age range of patients was 18-50 years. Three-fourth of study participants were males (75%).Average duration of injury was 15.8 ± 4.6 days. More than three-fourth were accident cases (84.4%) and had injury in hand (78.1%).Out of 32 patients, flap was successful in 31 patients. Only one flap was unsuccessful while complications were observed in 2 patients only. One had complication of wound infection and other had complication of marginal flap necrosis. Conclusion: This study concludes that PIA flap is a safe and reliable technique in reconstruction of soft tissue defects of hand and forearm. However, patients should be closely monitored post-operatively to detect any complications for timely surgical intervention. Keywords: Hand injury, Posterior interosseous artery flap, Plastic reconstruction surgery, Soft tissue defects, Venous congestion, Wrist Joint