Arch Hand Microsurg 2018; 23(3): 195-205  
Revisiting the Posterior Interosseous Artery Flap
Su Rak Eo1, Seung Hwan Hwang1, Ki Yong Hong1, Soo A Lim1, Gi Jun Lee2
1Department of Plastic and Reconstructive Surgery, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Korea
2Department of Orthopaedic Surgery, MS Jaegeon Hospital, Daegu, Korea
Correspondence to: Gi Jun Lee
Department of Orthopaedic Surgery, MS Jaegeon Hospital, 194 Dongdeok-ro, Jung-gu, Daegu 41905, Korea
TEL: +82-53-653-0119, FAX: +82-53-653-0770, E-mail:
Received: May 14, 2018; Revised: June 1, 2018; Accepted: June 11, 2018; Published online: September 1, 2018.
© Korean Society for Surgery of the Hand, Korean Society for Microsurgery, and Korean Society for Surgery of the Peripheral Nerve. All rights reserved.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The posterior interosseous artery (PIA) flap is one of the options for hand and upper extremity reconstruction. It does not sacrifice the main arteries of the hand, the radial and ulnar arteries and could be used even when either artery was damaged. The PIA is a branch of the common interosseous artery, which is about 1 cm in distance from the ulnar artery, and runs down longitudinally in the intermuscular septum between the extensor carpi ulnaris and extensor digiti minimi. PIA appears to be relatively constant in position, and pro a reliable blood supply in the posterior aspect of the forearm. The PIA flap is reliable in its designs, even to making it possible to close the donor site primarily. It provides not only a thin, pliable coverage of the hand and upper extremity, but also a neurosensory flap. Technically, the dissection of the PIA pedicle along its course needs a high learning curve, because it might present the risk of venous congestion, ischemic flap necrosis, and injury to the PIN. Although the flap dissection seems to be difficult, it still offers increased versatility in reconstructions of the hand, foot, and upper extremity.
Keywords: Reconstructive surgical procedures, Hand, Posterior interosseous artery

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