Observation of the Absence of Ulnar Artery in a Patient Planned to Free Dorsoulnar Artery Perforator Flap for Finger Defect: Is Preoperative Doppler evaluation of Perforator Alone Sufficient?

Abstract

Background Volar finger defects where critical structures exposed are always challenging for plastic surgeons. In these types of defects, local flaps, cross finger flaps, abdominal flaps, and free flaps are used. Free dorsoulnar artery perforator (DUAP) flaps and superficial palmar branch of radial artery (SPBRA) flaps are also used. In this case, we present a patient who was scheduled to receive a DUAP flap to address defect on the second finger of right hand; however, we repaired the defect with a SPBRA flap because intraoperative absence of the ulnar artery was observed. Materials and Methods A 34-year-old male patient was admitted with a wound that exposed the tendon and neurovascular bundle on the volar side of the second finger of the right hand. A free DUAP flap was planned for the patient. A perforator was detected during the preoperative Doppler ultrasound examination. While dissecting the perforator, we noted the absence of an ulnar artery proximal to the perforator vessel. The elevated SPBRA flap from same extremity and the defect were closed. Results Postoperative computer tomography showed an absence of the ulnar artery distal to the right antecubital region. No complications were seen in the donor and recipient areas. Long-term motor movements were natural, and the patient's quality of life was good. Conclusion Determining the perforator site using Doppler alone may not be sufficient in preoperative evaluation of patients scheduled to receive DUAP flaps. Performing an Allen test and using advanced imaging methods can prevent surgeons from encountering a bad surprise.

Comparison of Dorsoulnar Artery Perforator, Superficial Palmar Branch of the Radial Artery, and Superficial Circumflex Iliac Artery Perforator Flaps in Volar Finger Defects

“…The radial artery was determined lateral to the flexor carpi radialis tendon using a Doppler device. Superficial palmar branch of the radial artery elevation was performed as stated by Tatar et al 11 The arterial axis was determined proximal to the scaphoid bone. All the SPBRA flaps used in our study were designed vertically with the midline in the thenar crease.…”

Reconstruction of finger contracture with an expanded first dorsal metacarpal artery perforator flap: A case report

“…Other alternatives include the superficial palmar branch of the radial artery (SPBRA) flap and the dorsoulnar artery perforator (DUAP) flap with short pedicles that may not provide the required long pedicle. Also, super microsurgical equipment and techniques are needed (Tatar et al, 2021). Interpolation flaps have two stages, and abdominal or groin skin again does not provide glabrous and thin skin for volar defects.…”

“…Although it is advantageous to be sensitive in these flaps, they may be insufficient in large defects. Surgery for cross finger flaps is relatively easy, but prolonged immobilization may cause stiffness of the joint (Tatar et al, 2021). Free flaps are used when soft tissue defects in the finger cannot be closed with locoregional flaps.…”