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Soft-tissue repair in the hand often requires skin flaps due to exposure of bone, tendons, nerves, and arteries. However, alternatives for flap surgery are very limited, especially in dealing with palmar hand reconstruction. In the present report, the dorsal branch of the ulnar nerve and its accompanying artery were studied anatomically, and a neurocutaneous flap distally based on these structures was developed. The flap was raised on the medial aspect of the hand and distal half of the forearm, and its rotation point was located dorsally near the metacarpalphalangeal joints. The clinical use of this flap for the repair of skin defects in the hand is reported. All the clinical flaps survived completely, including a 3.5 x 13-cm large flap. Donor site morbidity was minimal. This flap represents a new alternative in hand reconstruction.

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