Reverse posterior interosseous flap based on an exteriorized pedicle to cover digital skin defects

The posterior interosseous arterial ¯ap is limited by its short vascular pedicle and proximal axis of rotation to the coverage of defects on the dorsal aspect of the hand and the ®rst web space. The authors present the results of three cases in which these limits were surpassed by extending the wrist and exteriorizing the vascular pedicle, thus causing it to bowstring across the angle created by the extended wrist. When ¯ap inset is complete the vascular pedicle is excised under local anaesthesia. This technique is an amalgamation of an island ¯ap and a traditional pedicle ¯ap and, as such, it is a two-stage procedure.