Dissecting the details: A case-based anatomical walkthrough of the antegrade posterior interosseous artery flap for elbow reconstruction.

The pedicled posterior interosseous artery flap is a reliable and effective option for reconstructing soft tissue defects in the upper extremity. Commonly described in a retrograde fashion for distal defects, its antegrade counterpart is less frequently reported, particularly in relation to elbow reconstructions. Additionally, there are few and less detailed descriptions on how to safely and correctly identify the posterior interosseous nerve (PIN) in the harvest. The current case describes the use of the pedicled antegrade posterior interosseous artery flap to resurface a complex elbow wound with exposed triceps tendon, exposed ulnar nerve and an open elbow joint. We present a detailed step-by-step harvest with the additional anatomical description of the topography of the PIN branches relative to the PIA pedicle.