Clinical Application of Distal Ulnar Artery Perforator Flap in Hand Trauma

Abstract

The clinical value of distal ulnar artery perforator flap in composite defects of the hand is demonstrated in a case series of nine patients with severe injuries of the hand. Soft tissue loss with a mean diameter of 3 × 4 cm on the dorsum of the hand, volar and dorsal side of the wrist and palm was reconstructed with this flap. The mean size of flaps was 5.2 × 5.2 cm. Tendon and nerve injuries, and metacarpal fractures accompanied the soft tissue loss in seven patients. Subsequent reconstructive procedures were; Hunter rod placement and tendon grafting in two patients, nerve grafting in one, primary extensor or flexor tendon repair in three, and metacarpal bone fixation in one patient. The mean follow-up period was 18 months. No complications related to the flap were observed. In this article, the advantage and disadvantages of distal ulnar artery perforator flap in hand and wrist reconstruction is discussed together with a review of literature.

Coverage of neuroma in continuity

“…The location of the dorsal branch of the ulnar artery is usually confirmed by Doppler sonography [ 14 ]. This is a constant artery with a diameter of 1 to 1.3 mm passing beneath the flexor carpi ulnaris (FCU) tendon [ 4 , 15 - 17 ]. The artery runs in an oblique line from the volar to the dorsoulnar surface of the distal forearm [ 15 ].…”

“…This is a constant artery with a diameter of 1 to 1.3 mm passing beneath the flexor carpi ulnaris (FCU) tendon [ 4 , 15 - 17 ]. The artery runs in an oblique line from the volar to the dorsoulnar surface of the distal forearm [ 15 ]. The artery divides into descending and ascending branches; the latter is responsible for the vascularization of the UAPAF [ 18 , 19 ] which measures up to 5-9 cm in width and 10-20 cm in length [ 15 , 16 , 18 , 19 ].…”

“…Ulnar retraction of the FCU permits identification of the perforator. While identifying the dorsal branch of the ulnar artery, attention is paid to the dorsal cutaneous branch of the ulnar nerve that may be encountered during this phase [ 15 ]. Usually the pivot point of the flap is localized 4 cm proximal to the pisiform bone [ 16 ].…”

Risk factors for pedicled flap necrosis in hand soft tissue reconstruction: a multivariate logistic regression analysis

“…Currently, the pedicled flap remains a mainstay in hand soft tissue defect reconstruction [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] due to the reconstructive principle of 'like-with-like'. However, partial or total flap necrosis remains the main complication and has a relatively high incidence.…”

Dorsal hand coverage

“…The options for coverage with a regional pedicle flap include the radial forearm flap [ 1 - 3 ], the ulnar forearm flap [ 4 , 5 ], the posterior interosseous flap [ 6 - 9 ] and the more recent distal ulnar and radial artery perforator-based flaps [ 10 - 13 ].…”