Posterior interosseous artery flap is a fascioseptocutaneous forearm flap supplied by the posterior interosseous artery. When it was first defined, it had a more limited area of use, but with the definition of its use as reverse flow over the distal pedicle, its area of use and popularity increased. Its advantages include not requiring major artery sacrification, having similar properties to the dorsal skin of the hand, being in the same surgical field as the defect area, and not requiring microsurgical intervention. The possibility of anatomical variation, the risk of venous congestion, and its close proximity to the posterior interosseous nerve are some of its disadvantages. The common interosseous artery branches into the anterior interosseous artery and posterior interosseous artery in the anterior forearm compartment. The posterior interosseous artery passes into the posterior forearm compartment and courses between the extensor carpi ulnaris and extensor digiti minimi muscles. At this point, it gives its perforations to the skin. The posterior and anterior interosseous arteries anastomose proximal to the distal radioulnar joint. The flap is dissected proximally, preserving the anastomosis between the anterior and posterior interosseous arteries. Skin perforators course within the fascia and septum. The proximity to the posterior interosseous nerve may require various modifications. The flap is then carried to the distal defect area in reverse flow.