Clinical application of posterior interosseous artery perforator flap with distalized rotation point for repairing skin defects of the dorsum of hand reconstruction&nbsp;

doi:10.13418/j.issn.1001-165x.2026.3.14

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Chinese Journal of Clinical Anatomy ›› 2026, Vol. 44 ›› Issue (3) : 338-342. DOI: 10.13418/j.issn.1001-165x.2026.3.14

Clinical application of posterior interosseous artery perforator flap with distalized rotation point for repairing skin defects of the dorsum of hand reconstruction

Huang Chengwei^1，2, Huo Yongxin²*, Bai Weifei², Fu Jiansong², Zhai Jingxiu³, Bao Qiying³, Gao Yuan³

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Abstract

Objective To investigate the design of a modified posterior interosseous artery (PIOA) perforator chain flap with a low rotation point based on the angiosome and perforasome theory, and to evaluate its anatomical basis and clinical efficacy in repairing skin defects of the dorsum of hand, dorsal fingers, and first web space. Methods A retrospective analysis was performed on 9 patients with complex soft tissue defects of the hand admitted between March 2024 and June 2025. There were 8 males and 1 female, aged 18-57 years. The causes of injury included machine crush injuries in 6 cases and blunt injuries in 3 cases. Defects were located on the dorsum of hand in 8 cases and on the ulnar side of the palm in 1 case. Fractures were combined in 8 cases, and isolated soft tissue defects in 1 case. All were severe acute hand trauma patients, with wound areas ranging from 2.5 cm×3.0 cm to 6.0 cm×11.0 cm. All wounds underwent secondary repair using the modified surgical technique. The rotation point was set at the level of the base of the 3rd and 4th metacarpals, and the flap was supplied by the perforator chain between the terminal cutaneous branches of the PIOA and the dorsal carpal arterial arch. Dissection was performed at the superficial layer of the deep fascia without isolating the main vascular trunk. The flap size ranged from 3.0 cm×3.5 cm to 6.5 cm×11.5 cm. The donor site was closed primarily or covered with full-thickness skin grafts. Results All 9 flaps survived completely, and all wounds achieved primary healing. The follow-up period was 5-12 months (mean 8.5 months). The texture and appearance of the flaps were satisfactory. The mean DASH score was 9.2. Suprafascial dissection ensured no injury to the PIN. Conclusions The modified low-rotation-point PIOA perforator chain flap utilizes the network blood supply of the perforator chain, and distalizing the rotation point effectively overcomes the reconstructive bottleneck for distal hand defects while avoiding the risk of posterior interosseous nerve injury, making it an ideal surgical method for repairing complex soft tissue defects of the distal hand.

Key words

Posterior interosseous artery / / / Perforator chain flap / / / Angiosome / / / Perforasome / / / Choke vessel

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Huang Chengwei, Huo Yongxin, Bai Weifei, Fu Jiansong, Zhai Jingxiu, Bao Qiying, Gao Yuan. Clinical application of posterior interosseous artery perforator flap with distalized rotation point for repairing skin defects of the dorsum of hand reconstruction [J]. Chinese Journal of Clinical Anatomy. 2026, 44(3): 338-342 https://doi.org/10.13418/j.issn.1001-165x.2026.3.14

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