Long-Term Vascular, Motor, and Sensory Donor Site Outcomes after Ulnar Forearm Flap Harvest

Abstract

Use of the ulnar forearm flap (UFF) is limited by concerns for ulnar nerve injury and impaired perfusion in the donor extremity. Twenty UFFs were performed over a 6-year period. All patients underwent postoperative bilateral upper extremity arterial duplex studies. A subset of postoperative patients (n = 10) also had bilateral upper extremity sensory and motor evaluations, and functional evaluation via the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH). Motor function was tested by digital and key grip dynamometry. Ulnar nerve sensation was tested by evaluation of one- and two-point perceived pressure thresholds and two-point discrimination using the Pressure-Specified Sensory Device (Sensory Management Services, LLC, Baltimore, MD). All UFFs were viable postoperatively. Mean follow-up was 28.8 months for vascular studies and 45.3 months for motor, sensory, and QuickDASH evaluations. Although mid and distal radial artery flow velocities were significantly higher in donor versus control extremities evaluated at less than 1 year postoperatively, there was no significant difference in extremities evaluated at later time points. Digital pressures, grip strength, key pinch strength, and ulnar sensation were equivalent between donor and control extremities. The mean QuickDASH score was 17.4 ± 23.8. The UFF can be harvested reliably and long-term follow-up shows no evidence of impaired vascular, motor, or sensory function in the donor extremity.

The Radial Artery’s Sacrifice in the Chinese Flap Is Not Deleterious to Patients

“…1,2,4,5,11,12,16,17 A widely discussed subject, albeit with few associated studies and publications, centers on whether sacrifice of the radial artery to perform the RFF is deleterious to the patient. 3,8,14 The objective of this study was to assess, by questionnaire, the complications at the RFF donor site reported, particularly those related to sacrifice of the radial artery.…”

Microvascular Reconstruction of Complex Nasal Defects: Case Reports and Review of the Literature

“…The free ulnar RFF, 11 – 13 free auricular helical flap, 2 free fibula osteocutaneous flap, 14 prelaminated temporoparietal fascial flap, 15 first dorsal metacarpal, and dorsalis pedis 9 are all alternative options for selected patients.…”

Radial vs ulnar forearm flap: a preliminary study of donor site morbidity

“…Nevertheless, the subjective evaluation of donor site morbidity by patients showed no significant differences between the two groups, and the most widely used method to assess it is the DASH questionnaire. In the literature, it has been reported that the median values of DASH for ulnar flaps range from 3.4 to 13.3 1015 . In our study, we observed similar values for both the UFFF (10) and the RFFF (7.4); this is maybe dependent on the closure technique with a transposition flap or with a full thickness skin graft, which gives a more effective protection of the tendons in RFFF.…”

“…The next step is the isolation, at a subfascial level, of the best perforators for vascularisation of the cutaneous island, until their emergence from the ulnar vascular pedicle, which is dissected distal to proximal. During this manoeuvre, it is necessary to divide the vascular bundle from the ulnar nerve, taking care to retract and protect it 10 .…”