A 24-year-old male suffered a severe crush injury to the left upper limb. After initial care, the patient presented with exposure of the osteosynthesis plate in the distal third of the radius and thrombosis of the radial and ulnar revascularisation anastomoses at the carpal level. The absence of reverse flow in the posterior interosseous artery was confirmed by Ultrasound Doppler.
After debridement, a radial-ulnar bypass with saphenous vein graft was performed to revascularise the limb. As a means of covering the osteosynthesis material and the distal anastomosis of the by-pass, a 15x7.5 cm posterior interosseous perforator helix flap was placed on the dorsal aspect of the forearm. The skin perforator was located 4 cm proximal to the distal joint.
Once the flap could be pivoted on the cutaneous perforator vessels of the posterior interosseous artery, it was rotated 90 degrees along the ulnar border of the forearm until it reached the volar aspect of the carpus. The donor site was covered with a partial skin graft.
