The posterior interosseous artery flap versus the adipofascial radial artery perforator flap in reconstruction of firecracker and homemade bomb blast injuries of the hand

Background: The soft tissues of the radial aspect of the hand are predominantly affected in firecracker and homemade bomb blast injuries. In such cases, regional flap options are quite appealing for defect coverage. We have compared the outcomes of using two pedicled regional forearm flaps in these injuries, the posterior interosseous artery flap (PIAF) and the adipofascial radial artery perforator flap (ARAPF).Methods: 37 patients underwent reconstruction of the hand with PIAF (20 cases) and ARAPF (17 cases) between January 2014 and December 2019. They were compared with regards to patient demographics, reconstruction techniques, short-term and long-term functional and aesthetic outcomes using the disabilities of the arm, shoulder and hand (DASH) score and the subjective satisfaction score (SSS).Results: All our flaps survived without any major complications affecting long-term outcome. We found no statistically significant difference between the two flaps in terms of patient demographics, flap paddle size, duration of hospital stay, DASH score and SSS for recipient site. However, significant difference was noted in the duration of surgery, method of donor site closure and SSS for the donor site.Conclusions: Both the PIAF and ARAPF can be considered in cases of soft tissue defects of the hand from firecracker or bomb blast injuries. Both preserve the major arteries of the hand while still having reliable vascular pedicle.

Reverse Posterior Interosseous Artery Flap: A Reliable, Comfortable and Versatile Flap for Coverage of Soft Tissue Defects of Hand

Background: Soft tissue defects of the hands require coverage with soft, pliable full-thickness skin. The posterior interosseous artery (PIA) flap fulfils all these requirements and also has significant advantages over other flaps; it is a single-stage procedure that does not sacrifice major vascular axis of the hand. However, the dissection can be challenging and requires meticulous skill. The objective of the study was to evaluate the reverse PIA flap for coverage of hand soft tissue defects in terms of its safety, reliability, comfort, function and aesthetic appearance.Methods: Over a period of 3 years, patients with soft tissue defects over the dorsum of the hand and first web space were observed. A standard PIA flap was raised using loupe magnification under general or brachial anesthesia. The size and location of the defect were noted along with the size and success of the flap.Results: Twelve patients, including nine males and three females, were taken up for this procedure. All the flaps survived completely except one with marginal necrosis not requiring a secondary procedure. All patients were quite satisfied with the procedure and went on to resume their work within a month or two.Conclusion: PIA flap is a safe, reliable option with great versatility for coverage of hand defects, especially over the dorsum. A well-planned flap surgery done under loupe magnification affords excellent results. The entire treatment also requires a shorter hospital stay and allows the patient to return to work quickly.