Reconstruction of Digital Defects with the Free Proximal Ulnar Artery Perforator Flap

Abstract

Background:The aim of post-traumatic digital reconstruction is to restore form and function, allowing early rehabilitation. In the absence of feasible local options, free tissue transfer can be a versatile and reliable alternative. The aim of this study was to describe our experience with the use of the free proximal ulnar artery perforator flap (PUPF). Methods: Our prospectively maintained free flap database was inquired for patients that had undergone digital reconstructions with free PUPFs. Results: Six patients that underwent digital reconstruction were eligible. The ipsilateral forearm was donor site of choice, with all flaps based on a perforator of the ulnar artery, without the need to compromise the main vessel. A superficial vein was routinely included with the flap. No flap failures were encountered. Mean hospital stay was 5.5 days, and all patients achieved a satisfactory functional result. Conclusions: The proximal ulnar perforator free flap offers an alternative for finger reconstruction, having the advantage of including thin and hairless skin from the proximal ulnar forearm. The vascular anatomy of the ulnar perforators seems to be constant. Furthermore, donor site morbidity is low, as the ulnar artery is not harvested with the flap, the donor site defect can generally be closed directly, and the scar is well concealed.

Tailored Skin Flaps for Hand Reconstruction

“…The PUPF’s main disadvantage is the perforator’s small diameter, which demands precise supermicrosurgical abilities to complete the anastomosis, as well as the flaps’ diameter, which, when larger than 6 cm, is mostly impossible to close the donor site, possibly requiring grafting. 17 In our study, no complications were observed in the long-term follow-up (Fig. 3 ).…”

“…In this study, the PUPF was the second most commonly used flap; based on the perforator of the ulnar artery, it was employed in 13.9% of our small defect repair interventions (the surgical technique employed to harvest the flap is well described in a previous article). 17 The PUPF also has been used to cover digits but with larger defects, mostly when two adjacent fingers were injured, covering both defects and performing the syndactyly release in the second intervention.…”

Beauty and Function: The Use of Trimmed Great Toe in Thumb and Finger Reconstruction

“…Local flaps, such as homodigital and heterodigital flaps, [7][8][9][10] pedicled hand and forearm flaps, or thin free flaps, 11,12 are commonly used to replace the loss of substance. However, these procedures do not restore the injured finger's original length and tissue complexity, resulting in poor functional and cosmetic outcomes.…”

Thinking Out of the Box: Use of the Radial Artery Distally to the Snuffbox as Recipient Vessel

“…Accordingly, to the defect, flaps harvested from different areas of the body may be employed. [1][2][3][4][5][6][7][8][9][10][11][12][13][14] As in all body surfaces, the viability of reliable recipient vessels is essential in reconstructive surgery. Different from the volar aspect of the hand, there is only one main vessel in the hand dorsum, namely the radial artery (RA).…”

“…Accordingly, to the defect, flaps harvested from different areas of the body may be employed. 1 – 14 …”