Designing the Perfect PIA Flap, with Prof. Claudio Angrigiani

📩 **Subscribe to The Plastics Fella Newsletter:** https://www.theplasticsfella.com In this episode of *How I Operate*, Ryan Sugrue is joined by **Professor Claudio Angrigiani**, the creator of the Posterior Interosseous Artery (PIA) flap and one of the pioneers of perforator flap surgery. Looking back over four decades of innovation, Professor Angrigiani shares the story behind the development of the PIA flap, from cadaveric anatomy studies in Argentina to its adoption as a reliable reconstructive option for hand and wrist defects around the world. Along the way, he explores the importance of anatomy, surgical simplicity, and why understanding vascular territories remains fundamental to flap design today. **Key Takeaways:** - How the PIA flap was developed as an alternative to traditional reconstructive options for the hand. - The role of anatomical research and cadaveric studies in creating dependable surgical techniques. - Why the middle perforators are key to the reliability of the PIA flap. - Common technical mistakes that can lead to complications or flap failure. - The importance of simplifying flap surgery through a deep understanding of anatomy. - Professor Angrigiani's approach to innovation, research, and developing new surgical techniques. **Chapters:** 00:00 – Introducing the PIA Flap 04:10 – Hand Reconstruction in the 1980s 09:25 – The Origins of the PIA Flap 16:40 – Early Anatomical Research and Cadaver Studies 24:15 – Understanding Perforators and Vascular Territories 33:50 – The Physiology Behind the PIA Flap 43:20 – Flap Design, Landmarks, and Planning 54:35 – Raising the PIA Flap Step by Step 01:06:10 – Common Mistakes and Avoiding Complications 01:15:45 – Innovation, Anatomy and Surgical Thinking Thank you for listening to *How I Operate*. Brought to you by ThePlasticsFella. If you enjoyed this episode, please follow the show, leave a rating and review, and share it with colleagues. New episodes are released bi-weekly, featuring the surgeons, innovators, and ideas that continue to shape modern plastic surgery.