Anatomical Analysis of Cutaneous Perforator Distribution in the Forearm

Kimura, Tomomi; Ebisudani, Shogo; Osugi, Ikuko; Inagawa, Kiichi

doi:10.1097/gox.0000000000001550

Cited by 13 publications

(13 citation statements)

References 27 publications

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“…As reported by Inoue and Taylor, 10 it is safer to include perforators from a radial and ulnar recurrent artery to stabilize blood flow near the cubital fossa. To do so, we included superficial flexor muscles to the flap, and it is possible to easily incorporate musculocutaneous perforators of ulnar and radial arteries 10–13 …”

Section: Discussionmentioning

confidence: 99%

“…To do so, we included superficial flexor muscles to the flap, and it is possible to easily incorporate musculocutaneous perforators of ulnar and radial arteries. [10][11][12][13] Some have also suggested that the postoperative contour of the shoulder is better to fit a prosthesis if the flap has a volume of flexor muscle groups. 2,14 Concerning the size of the flap that can be harvested, Kimura et al 11 reported that the average length of the forearm from the volar aspect of the pisiform bone to the medial epicondyle of the humerus was 22.8 cm.…”

Section: Discussionmentioning

confidence: 99%

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Soft Tissue Reconstruction Using the Free Forearm Fillet Flap in the Salvage of Forequarter Amputations for Recurrent Sarcoma

et al. 2023

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Reconstruction after radical forequarter amputation for recurrent proximal extremity sarcoma is challenging because the defect is significant, and the axillary or subclavian vessels are resected with the tumor, indicating that the pedicle of nearby flaps is often cut off. Free flaps are commonly used to cover the defect, but the donor site morbidity is problematic. Another problem with resecting the axillary or subclavian vessels is difficulty obtaining recipient vessels with matching calibers for another free flap. The authors presented 2 cases that successfully solved all these problems by covering the defects by the forearm fillet flaps.The forearm fillet flap has the advantage of using a portion that is usually discarded, so there is no donor site morbidity. Moreover, using the brachial artery as the pedicle of the flap allows the anastomosis to the stump of the resected axillary or subclavian artery because differences in caliber are slight.The use of the forearm fillet flaps has been reported less frequently than the fillet flaps in the lower extremities, and most cases are posttraumatic. In cases of trauma, complications are reported to occur in about 1 in 4 patients, but in cases after tumor resection, ischemic time can be controlled, and there are no risks of contamination or unnoticed forearm damage, so more stable results can be expected as in this report.Using the free flap from the distal portion of the resected upper limb, especially in cases with a short prognosis, is a viable option that effectively minimizes damage to the donor site and maintains quality of life.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Soft Tissue Reconstruction Using the Free Forearm Fillet Flap in the Salvage of Forequarter Amputations for Recurrent Sarcoma

et al. 2023

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“…3 Their findings have been supported by other studies that found that ulnar cutaneous perforators are densely represented in an area located between the middle and the proximal one-third of the forearm. 5,6,16,26 Known that in this work, we focused the area of interest in the proximal one-third of the forearm for two main reasons. The first one relates to the fact that we wanted to further investigate the presence of perforators directed to the skin originating from ulnar recurrent arteries, which are located in this area.…”

Section: Discussionmentioning

confidence: 99%

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Cherubino

Bolletta

Baroni

et al. 2020

J Reconstr Microsurg

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Background The purpose of this study is to document the vascular anatomy of the free ulnar artery proximal perforator flap and to highlight the possibility of harvesting it based on the perforators originating from the posterior ulnar recurrent artery (PURA), to spare both the main axis of vascular supply to the hand. In addition, we present a case series of five patients treated for soft tissue defects of the hand with free ulnar artery proximal perforator flaps. Methods Ten specimens of anterior forearm were dissected in this study to register number and characteristics of ulnar perforators. The dissection was focused on the perforators originating from the larger branch of the ulnar artery, the PURA, at the proximal third of anteromedial forearm. The anatomical dissections were evaluated in relationship with clinical dissections performed during flap harvesting in five patients. Results In three of the specimens dissected, the proximal perforator originated from the PURA, and in the other seven specimens, it originated directly from the ulnar artery. Five cases of reconstruction of the hand were performed with success using the free ulnar artery proximal perforator flap, and in two cases, the perforator from the PURA was found and it was possible to raise the flap based on this branch of the ulnar artery. Conclusion The free ulnar artery proximal perforator flap can be harvested in two different manners for the same skin island of the forearm. When possible, harvesting it form the PURA allows lengthening of the pedicle. In our experience, this flap presents many advantages such as thinness and hairlessness; it allows preservation of the ulnar neurovascular bundle with an acceptable donor site morbidity. Level of evidence: IV.

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“…An in-depth description on correct program selection and device settings regarding perforator mapping and characterization for microsurgeons has been described by Kehrer et al 18,19 In our study, the analysis for UAPs using US was performed between the pisiform and 100 mm proximal to the pisiform, which was the distal half in the volar forearm. To compare with previous reports, the location of UAP was mapped as described by the previous reports [20][21][22][23][24][25] (►Fig. 5).…”

Section: Discussionmentioning

confidence: 99%

Identification of Ulnar Artery Perforators Using Color Doppler Ultrasonography

Ishiko

Yano

Onode

et al. 2020

J Reconstr Microsurg

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Background The ulnar artery perforator (UAP) flap, which is hairless, thin, and pliable, has been used for the reconstruction of soft tissues from the finger to the elbow. Preoperative planning is essential for a perforator flap surgery, and there are some tests to identify perforators. Color Doppler ultrasonography (US) with a high-frequency transducer helps in detecting decreased flow in smaller vessels, such as perforators. The purpose of this study was to determine the anatomical locations and origins of perforators arising from the ulnar artery using color Doppler US in healthy volunteers. Methods Forty forearms of 20 healthy volunteers were included in the study. Perforators arising from the ulnar artery, within 100 mm proximal to the pisiform, were investigated using color Doppler US with a high-frequency transducer. Results A total of 205 perforators were identified. On comparing the locations in each 20 mm section from the pisiform, the largest number of perforators was 58 (28%), within 20 mm proximal to the pisiform. The axial view demonstrated 44 (21%), 64 (31%), 32 (16%), and 65 (32%) perforators in the radial, ulnar, superficial, and deep aspects of the ulnar artery, respectively. Fifty-two and 28 essential perforators were supplied by the UAPs arising from the superficial and ulnar aspect within 20 mm proximal to the pisiform and between 21 and 40 mm proximal to the pisiform, respectively, while elevating the UAP flap. Conclusion This is the first study to assess the UAP using color Doppler US. Identification of UAP using color Doppler US can be used as a preoperative assessment for reliable elevation of a UAP flap.

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Anatomical Analysis of Cutaneous Perforator Distribution in the Forearm

Cited by 13 publications

References 27 publications

Soft Tissue Reconstruction Using the Free Forearm Fillet Flap in the Salvage of Forequarter Amputations for Recurrent Sarcoma

Soft Tissue Reconstruction Using the Free Forearm Fillet Flap in the Salvage of Forequarter Amputations for Recurrent Sarcoma

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Identification of Ulnar Artery Perforators Using Color Doppler Ultrasonography

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