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Use of the Reversed Posterior Interosseous Flap in Staged Reconstruction of Mutilating Hand Injuries before Toe Transfers

The goal of treatment in metacarpal hand amputations is the reconstruction of a tripod pinch (two ulnar digits plus an opposable thumb). Achieving this goal requires toe transfers in a variety of combinations that have been well described in the literature.1–9 Because of the limited amount of skin that can be transferred with the toes, a skin flap is usually necessary, typically before toe transfer. A pedicled groin flap is typically considered the best option because it is a simple technique and does not use valuable recipient vessels.1–4,6,7,9 This approach entails two surgical procedures and limits the mobility of the patient for 3 weeks. Free tissue transfer has been used simultaneously with toe transfers to provide skin coverage at the expense of increasing the complexity of the procedure.10 The use of pedicled regional flaps for providing skin coverage before toe transfer has typically been discouraged because the resulting scars make subsequent toe transfers more difficult.1–4 The use of the pedicled posterior interosseous flap to provide skin coverage for reconstructing metacarpal hands is reported here in a clinical series.