DefinePK

Research Objective

To evaluate the reverse PIA flap in the reconstruction of various soft tissue defects of the hand in terms of reliability, flap survival, total duration of hospital stay, patient satisfaction, and duration of return to work.

Methodology

Case Series study conducted at Jinnah Burn and Reconstructive Surgery Center, Lahore, from January 2018 to July 2020. Twenty-three reverse posterior interosseous artery flaps were used for coverage of soft tissue defects in patients aged 15 to 60 years. Surgeries were performed by a single surgeon using a described operating technique, with postoperative monitoring by the same team.

Methodology Flowchart

                        graph TD
    A["Patient Selection 15-60 years"] --> B["Soft Tissue Defect of Hand/Wrist"];
    B --> C["Flap Design & Elevation"Reverse PIA""];
    C --> D["Surgical Debridement"];
    D --> E["Flap Coverage of Defect"];
    E --> F["Donor Site Grafting"];
    F --> G["Postoperative Splinting & Elevation"];
    G --> H["Flap Monitoring"];
    H --> I["Outcome Assessment"Survival, Stay, Satisfaction, Return to Work""];
    I --> J["Conclusion"];                    

Discussion

The reverse PIA flap is presented as a safe, versatile, and reliable option for hand and wrist defect coverage, offering advantages such as single-stage procedure, lack of dependency on distant flaps, localized donor site deformity, and early mobilization. It spares major hand blood vessels (radial and ulnar arteries) compared to other forearm flaps. The study highlights the importance of meticulous dissection, perforator identification, and inclusion of a fascial sleeve for optimal results.

Key Findings

Out of 23 flaps, 22 survived completely. One patient experienced partial flap necrosis, which was managed with skin grafting. Donor sites were successfully covered with skin grafts. All patients resumed work within one to two months and were satisfied with the aesthetic outcome. The mean hospital stay was 10.9 days.

Conclusion

The reverse posterior interosseous flap is a versatile, safe, and reliable option for covering soft tissue defects of the hand and wrist. Key requisites for reliability include perforator identification, meticulous dissection, preserving a fascial sleeve, and incorporating dominant perforators. Its single-staged nature leads to shorter hospital stays, early mobilization, and superior aesthetic outcomes, making it a preferable choice for patients.

Fact Check

1. Number of flaps used: 23 reverse posterior interosseous artery flaps were used in the study. (Confirmed in "Material & Methods" and "Results").
2. Flap survival rate: 22 out of 23 flaps survived completely, indicating a survival rate of approximately 95.6%. (Confirmed in "Results").
3. Study period: The study was conducted from January 2018 to July 2020. (Confirmed in "Material & Methods").

Mind Map