Prospective observational study of clinical outcomes in using posterior interosseous free flap for finger defects

Finger injuries are common in hand and plastic surgery practice. There are various options for reconstructing finger defects. Moderate sized skin defects of the fingers which need flaps are commonly covered using various abdominal flaps. These conventional workhorse flaps are thick, need two-staged procedures and require the hand to be kept in a cumbersome position. The radial artery or the ulnar artery flap need sacrifice a major vessel. To address the above, we have used the posterior interosseous artery free flap to cover finger defects. This was a prospective observational clinical study done on 15 patients admitted to a tertiary level hospital from July 2017 to July 2021. These patients had accidental industrial injuries with a loss of soft tissue on the fingers. There were finger fractures in 6 cases. These patients underwent posterior interosseous artery free flap cover. The flap size ranged from 6 × 3 cm to 10 × 4 cm. We had to cover the donor defects with skin graft in all our cases. Fourteen out of 15 flaps survived, with loss of one flap due to venous congestion. The mean two-point discrimination was 7.8 mm, with a total active motion percentage of more than 70% in 11 out of 15 cases. The posterior interosseous artery flap is a thin and pliable one stage flap, and may not need further flap thinning either, thereby establishing itself as a single stage procedure and moreover not requiring sacrifice a major vessel.