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Authors Dr Maksud Devale, Dr Rohit Munot, Dr Amarnath Munoli Dept of Plastic Surgery, LTMG Hospital, Sion, Mumbai-22, India Corresponding Author Dr Rohit Munot Assistant Professor, Dept of Plastic Surgery, LTMG Hospital Sion, Mumbai-22, India Ph No: +919860122763/ 02224043141, Email: rohitmunot@gmail.com Abstract Distally based posterior interosseous artery (PIA) flap is a very useful flap for defects on hand. Dissection of flap is not easy unless certain anatomical landmarks are identified and preserved throughout the dissection. We suggest here few refinements which not only improve reliability of flap but also may reduce operative time. We start with an incision in the distal forearm on ulnar border of the flap. This ensures rapid and accurate identification of the septum. Similarly, we describe other modifications such as design of skin paddle, identification of communicating branch, transfer of flap among others.

Refinements in the surgical technique to harvest distally based posterior interosseous artery flap