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Soft tissue cover to the hand can be as simple as a skin graft, local, distant flaps to a complex microvascular free flap. Posterior interosseous artery (PIA) flap is a technically demanding robust flap which can be used to cover a wide range of hand and wrist defects. We report a 25-year-old lady who had severe crush injury where the posterior interosseous flap was planned to cover the dorsum of hand defects. On exploration carefully, the PIA was found to be congenitally absent. An alternative groin flap salvaged the procedure and the patient had good aesthetic and functional outcomes at the five years of follow-up.

Congenital Absence of Posterior Interosseous Artery: A New Anatomic Variant of the Posterior Interosseous Artery Flap