Impossible harvest of the posterior interosseous artery flap: a report of an individualised salvage procedure

Although the posterior interosseous artery flap represents a reliable technique to provide vascularised skin cover for the dorsum of the hand, the dissection of the flap is often very difficult because of anatomical variants. The weakest part of the vascularisation is the middle third of the posterior interosseous artery. Whenever it is discovered during the operation that such a flap is impossible to harvest, or likely to be unreliable, there is an immediate need to choose an alternative. Such a case is reported here. The individual anatomical situation allowed the dissection of a flap, the pedicle of which carried its blood supply from a perforating branch of the anterior interosseous artery. The technique described offers an individual solution to the problem of skin coverage when the harvest of the posterior interosseous artery is impossible.