The posterior interosseous artery (PIA) flap is a pedicle flap that can be harvested at the posterior forearm based on blood supply from the PIA and its concomitant veins. The flap can be used for posttrauma coverage of exposed bones, tendons, and defects; for treatment of a surgical wound; or as a spacer in congenital or burn-related contracture releases. The surgical technique has been reported with limited donor morbidity and few complications to cover exposed structures. In this article, we present our methods and experience using a modification of the posterior interosseous flap that was deepithelized to fill a 3-dimensional cavity in the hand. This method has been successfully used, and the example of the patient shows good outcome, function, and range of motion with no significant complications. The deepithelized PIA flap is a technique that surgeons may add to their toolbox for 3-dimensional defect coverage in the hand. It offers the following advantages: (a) technically uncomplicated; (b) does not create significant donor site morbidity; (c) does not sacrifice any major vessels; and (d) provides good cosmetic appearance, especially in the dorsum of the hand.
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