Imaging the posterior interosseous artery with computed tomographic angiography: report of a rare anomaly and...

Although the posterior interosseous artery flap has been used extensively for the coverage of dorsal hand defects, anatomic variations in the artery have been widely described. These variants have led to reports of flap failure or conversion to alternative salvage procedures. Preoperative imaging has been suggested in the past prior to posterior interosseous artery flaps as a result of these anatomic variations, particularly with Doppler ultrasound. We describe a new technique for imaging the posterior interosseous artery preoperatively, the use of computed tomography angiography, a highly accurate, noninvasive technique that can highlight the anatomy and allow safe planning for alternative reconstructive options in complex cases. A unique case is described where the posterior interosseous artery was completely absent throughout its course, and in which preoperative imaging was able to potentiate a good outcome.