Posterior Interosseous Artery Flap: Anatomy, Applications, and Outcomes

The posterior interosseous artery (PIA) flap remains an important regional reconstructive option for soft tissue defects of the hand and wrist because it provides thin, pliable tissue while preserving the major vascular axes of the forearm. This narrative review discusses the anatomical basis, surgical technique, indications, outcomes, complications, and comparative role of the PIA flap in contemporary upper limb reconstruction. Current literature demonstrates generally favorable functional and aesthetic outcomes with reliable soft tissue coverage, particularly for defects involving the dorsal hand, wrist, thumb, and first web space. Although venous congestion and anatomical variability remain recognized limitations, careful surgical planning and technical modifications may reduce complication rates. Compared with alternative regional and free flap options, the PIA flap continues to serve as a valuable vessel-preserving reconstructive technique, particularly for moderate-sized defects requiring durable coverage and satisfactory functional recovery. However, the available evidence is derived predominantly from retrospective case series and observational studies, highlighting the need for prospective comparative studies to further define its role in contemporary upper limb reconstruction.