Posterior interosseous free flap with extended pedicle for hand reconstruction

The anatomy of the posterior interosseous vessels makes them suitable as a donor area of free flap. The skin island can be designed on the perforating vessels of the distal third of the forearm, up to the dorsal wrist crease, to increase the pedicle length (7 to 9 cm). A series of nine flaps transfe rred to reconstruct hand defects is presented. All flaps were designed over the dorsal distal forearm, and dimensions permitted direct closure of the donor site (up to 4 to 5 cm wide). Apart from a linear scar, donor morbidit y was negligible. All transfers were successful. Although its dissection is somewhat tedious, the anatomy of the vascular pedicle is suitable for micr oanastomosis and the skin island is thin, although hairy. The posterior int erosseous free flap with extended pedicle may be a good choice when limited amounts of thin skin and a long vascular pedicle are needed.