Use of Free Modified Innervated Posterior Interosseous Artery Perforator Flap to Repair Digital Skin and Soft Tissue Defects.

Current techniques to reconstruct soft tissue of the fingers result in scarring and functional deficits. Perforator flaps raised on the posterior interosseous artery are thin and well vascularised, and cause minimal donor site scarring. Using a flap with sensory nerves was hoped to contribute to the desired postoperative sensory recovery of fingers. We used modified innervated posterior interosseous perforator flaps to repair digital defects in 18 patients. Injuries included digit amputations and palmar soft tissue defects. The posterior antebrachial cutaneous nerve was carried in the flap and bridged with the defect section of the proper digital nerve. The flaps used measured 10 cm × 6 cm to 5 cm × 3 cm. All 18 flaps survived; one necrotic edge eventually healed. During the 10-28 months of follow-up (average, 14 months), two-point discrimination in flaps and injured fingers was 6-15 mm. Good functional and sensory outcomes were obtained in primary operation, and patients were generally satisfied with the aesthetic results. Further work will be needed to assess the branches of the posterior interosseous artery preoperatively to improve surgical planning.