Abstract

To demonstrate the versatility of the reverse flow PIA flap, and technical modifications for safe execution and enhanced survival of the flap, in a high volume tertiary care center. PATIENTS AND METHODS: Between January 2019 and June 2022, 33 patients presented with soft tissue defects in dorsum of hand, first web space, and flexor aspect of wrist region, resurfaced with PIA flaps were included in the study. All flaps were done for reconstruction of post traumatic defects in hand. In Patients with fractures in the hand and tendon loss, fracture fixation and tendon reconstruction followed by resurfacing was done. Patients were taken up for surgery under regional anesthesia, under tourniquet control with loupe magnification. In supine position, flap markings done with elbow and forearm placed in flexed and semi pronated position. Preoperative Doppler was performed for identifying the perforator in the cutaneous paddle marked along the axis. Once the patient is positioned on table, planning in reverse done along the axis and flap was harvested. Flap inset done and donor raw area covered with SSG with immobilization of wrist in 30 degree extension and MCP joints in 60 degree flexion with volar slab. Patients were instructed strict hand elevation for a week. All patients were under clinical observation for 2 weeks. Complications such as infection, venous congestion, donor site SSG loss, and extension lag in fingers were noted. Patients were advised follow up in physiotherapy and later reassessed at the end of 3 months for donor site scar and functional recovery. Patients with major associated injuries and injury to either radial or ulnar artery in the forearm were excluded.

Description