The Number of Perforators Included in Reversed Flow Posterior Interosseous Artery Flap: Does It Affect the Incidence of Venous Congestion?

BACKGROUND: The purpose of this study is to decrease the incidence of venous congestion occurring in the reversed flow posterior interosseous artery flap used for coverage of hand defects. METHODS: This may be achieved by studying the incidence of venous congestion in flaps including only 1 perforator and comparing the results with others including more than 1 perforator both in small and large sized flaps. RESULTS: This study showed that inclusion of only 1 perforator in the flap decreased the incidence of venous congestion with complete flap loss in flaps to 5%. Also, it decreased the incidence of venous congestion with partial flap loss in flaps to 10%. CONCLUSIONS: The small sized reversed flow posterior interosseous artery flap should be less than 40 cm(2) and should include only 1 perforator to decrease the incidence of venous congestion with partial and complete loss of the flap. The level of evidence for this study is the type II prospective comparative study.