الفهرس 
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Abstract
The PIOA was constant in all cadaveric dissections along the whole course. The PIOA gave off 4-8 septocutaneous perforators (mean 5.90 ± 1.33) along its course in the intermuscular septum between the ECU and the EDM muscles. (Table 1, figure 13). The number of perforators in the middle third of the forearm was 2-4 (mean 2.50 ± 0.61).
The mean distance of the distal most perforator in the middle third forearm from the ulnar styloid was 10.39 ± 1.54 cm (range 7.30 – 12.90 cm). The anastomosis between the PIOA and the AIOA was there in all specimens. The mean distance of anastomosis between PIOA and AIOA from the ulnar styloid was 2.87 ± 0.56 cm (range 1.70 – 3.80 cm). The mean pedicle length was 7.52 ± 1.21cm (range 5.10 – 9.80 cm). The communicating artery located proximal and radial to the ulnar styloid.
Twenty PIAFs were performed in the current study; 10 with extra superficial vein anastomosis (VS-PIAF) and 10 without venous super-drainage (conventional PIAF). Each group contained 9 males and a female.
The conventional PIAF group’s mean age was 29.80 ± 12.59 years (range 2 – 45). The sites of the defects were dorsum hand in 5 patients, 1st web space contracture in 3 patients and hand amputation stump coverage in two patients. The causes of the defects were post traumatic defects in 6 cases, post traumatic contractures in 3 cases and post burn contracture in a single case.
The VS-PIAF group’s mean age was 33.20 ± 13.38 years (range 16-54). The sites of the defects were dorsum hand in 7 patients and 1st web space contracture in 3 patients. The causes of the defects were post traumatic defects in 7 cases, post traumatic contractures in 2 cases and post burn contracture in a single case.
The mean flap surface area in the conventional PIAF group was 65.95 ± 35.03 cm2 (range 16.5 – 140 cm2) while in the VS-PIAF group was 79.50 ±37.88 cm2 (range 35 – 168 cm2).
In the conventional PIAF group the flap width ranged from 3 to 10 cm, while the length ranged from 5.5 to 14 cm. In the VS-PIAF group the flap width ranged from 4 to 12 cm, while the length ranged from 7 to 14 cm.
The donor sites closed directly in 5 cases of the conventional PIAF group and in 3 cases of the VS-PIAF group. Direct closure performed in flaps less than 6 cm in width. Skin grafts were used in 5 cases of the conventional PIAF group and in 7 of the VS-PIAF group for donor sites coverage.
The mean operative time in the conventional PIAF group was 100.30 ± 9.91 min. (range 88 – 120 min.) while in the VS-PIAF group was 163.0 ±10.33 min. (range 145 – 180 min.). 63 min. increase in the operative time in the VS-PIAF group compared to the conventional PIAF group represented the time needed for dissection, preparation and anastomosis of the extra subcutaneous vein.
Venous congestion occurred in a single case (10%) of the conventional PIAF group which was managed conservatively by leech therapy and change of dressings. Necrosis of the distal third of the flap was inevitable with poor results as the patient needed secondary surgical procedure for second web space reconstruction. Excellent results were obtained in the other 9 cases (90%).
Venous congestion occurred in a single case (10%) of the VS-PIAF group and managed conservatively by change of dressings. Tip necrosis encountered with good results, no secondary surgical procedure was needed. Partial donor site graft loss noted in another case and managed conservatively by change of dressings with excellent results. Excellent results were obtained in 90% of cases.
No venous congestion noted when the proximal limit of the flap was distal to the proximal fourth of the forearm and when the PIAF was used for dorsal hand defects down to the metacarpophalengeal joints and first web space.