{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T07:44:33Z","timestamp":1792136673698,"version":"4.4.0"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":14,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Microsurgery"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The pedicled reverse\u2010flow posterior interosseous artery (PIA) flap is a reliable option for soft\u2010tissue reconstruction of the hand and wrist. However, the predictors of complications and the impact of early revision surgery have not been adequately evaluated using multivariable analysis. This study aimed to investigate the factors affecting flap survival, complication rates, and outcomes of salvage surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods<\/jats:title>\n                    <jats:p>A retrospective analysis was conducted on 110 patients who underwent reconstruction with a pedicled reverse PIA flap between 2010 and 2025. Univariable and multivariable logistic regression analyses were performed to identify predictors of venous congestion, flap loss, and donor site grafting. Receiver operating characteristic (ROC) analysis was used to determine the dimensional thresholds.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The mean patient age was 34.2\u2009years, and the majority of defects were traumatic in etiology (80.9%). Venous congestion occurred in 30 patients (27.3%), whereas total and partial flap loss occurred in five (4.5%) and 15 (13.6%) patients, respectively. On multivariable analysis, flap length was independently associated with venous congestion (OR\u2009=\u20091.45, 95% CI 1.17\u20131.79;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and flap loss (OR\u2009=\u20091.47, 95% CI 1.17\u20131.85;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). ROC analysis identified a flap length of 9\u2009cm as a practical reference threshold (high specificity, modest sensitivity) for these complications. In a separate donor\u2010site grafting model, flap width &gt;\u20094\u2009cm was associated with grafting on univariable analysis but became only borderline significant after multivariable adjustment (OR 1.60, 95% CI 0.98\u20132.60;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.059), while traumatic etiology was independently associated with donor site grafting (OR\u2009=\u20098.00, 95% CI 2.20\u201329.03). Among patients with venous congestion, early revision was associated with a lower flap loss rate than conservative management (43.75% vs. 92.86%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In reverse\u2010flow PIA flap reconstruction, greater flap length was independently associated with venous congestion and flap loss. Traumatic etiology emerged as an independent predictor of donor\u2010site grafting, an association that has received little prior attention. In patients with venous compromise, early revision was associated with a lower overall flap loss rate, although this observational finding requires confirmation in prospective studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/micr.70307","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:48:52Z","timestamp":1792133332000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Complications and the Role of Early Revision in Reverse\u2010Flow Posterior Interosseous Artery Flaps: A Multivariable Analysis of 110 Cases"],"prefix":"10.1002","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6759-6636","authenticated-orcid":false,"given":"Kubilay","family":"Erol","sequence":"first","affiliation":[{"name":"Hand and Microsurgery &amp; Orthopaedics and Traumatology (EMOT) Hospital  Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7925-6591","authenticated-orcid":false,"given":"Can","family":"Yener","sequence":"additional","affiliation":[{"name":"Hand and Microsurgery &amp; Orthopaedics and Traumatology (EMOT) Hospital  Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7658-6106","authenticated-orcid":false,"given":"Bak\u0131t","family":"Kerekulov","sequence":"additional","affiliation":[{"name":"Hand and Microsurgery &amp; Orthopaedics and Traumatology (EMOT) Hospital  Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9234-7922","authenticated-orcid":false,"given":"Erdem","family":"Er","sequence":"additional","affiliation":[{"name":"Hand and Microsurgery &amp; Orthopaedics and Traumatology (EMOT) Hospital  Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4022-5821","authenticated-orcid":false,"given":"\u00d6zg\u00fcn Bar\u0131\u015f","family":"G\u00fcnt\u00fcrk","sequence":"additional","affiliation":[{"name":"Hand and Microsurgery &amp; Orthopaedics and Traumatology (EMOT) Hospital  Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"issue":"3","key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.jhsa.2011.12.031","article-title":"The Reverse Posterior Interosseous Artery Flap: Technical Considerations in Raising an Easier and More Reliable Flap","volume":"37","author":"Acharya A. M.","year":"2012","journal-title":"Journal of Hand Surgery"},{"issue":"2","key":"e_1_2_9_3_1","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1016\/j.bjps.2005.06.002","article-title":"The Reverse Posterior Interosseous Flap: A Solution for Flap Necrosis Based on a Review of 87 Cases","volume":"59","author":"Akinci M.","year":"2006","journal-title":"Journal of Plastic, Reconstructive & Aesthetic Surgery"},{"issue":"2","key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1097\/00006534-199308000-00014","article-title":"Posterior Interosseous Reverse Forearm Flap: Experience With 80 Consecutive Cases","volume":"92","author":"Angrigiani C.","year":"1993","journal-title":"Plastic and Reconstructive Surgery"},{"issue":"2","key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/j.hcl.2013.12.003","article-title":"Anatomy and Physiology of Perforator Flaps of the Upper Limb","volume":"30","author":"Appleton S. 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