The Fascia-Only Reverse Posterior Interosseous Artery Flap

Purpose Fascia flaps are a preferred method to reconstruct the soft tissue envelope of the hand when a thin and pliable flap is required to cover exposed tendons. The aim of this study was to report on our experience with the fascia-only reversed posterior interosseous artery flap. Contrary to commonly used fascia flaps, this flap does not require free tissue transfer. Methods In this retrospective review, 5 patients were identified, each of whom underwent soft tissue reconstruction with a reversed posterior interosseous artery fascia flap. The operative technique is similar to the harvest of a fasciocutaneous flap except that only the fascia is harvested through a straight incision. Results No flap loss occurred. In 2 patients a distal wound dehiscence occurred, which healed by secondary intention. No venous congestion or iatrogenic lesion of the motor nerves to the extensor muscles was encountered. Conclusions The fascia-only reverse posterior interosseous artery flap represents a locally available, pedicled option. With regard to the quality of the transferred tissue, this flap is comparable to the temporalis fascia flap. Major advantages are that the donor site is confined to the ipsilateral extremity and microsurgery is not required. Contrary to the fasciocutaneous version, no skin graft has to be applied to the donor site, which improves cosmesis. We consider this flap a worthwhile alternative to other fascia flaps. Type of study/level of evidence Therapeutic V.