Reconstruction of finger composite defects with perforator free flap from the superficial palmar branch of radial artery

Aksoy, Alper; Sır, Emin; Dağdelen, Dağhan; Aksoy, Meliha Kasapoğlu

doi:10.4103/tjps.tjps_7_17

Cited by 3 publications

(13 citation statements)

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“…Damage to the recurrent motor branch of the median nerve in SPBRA increases morbidity compared with the dorsal sensory branch of the ulnar nerve during DUAP elevation. 11 In our case, a Doppler device detected a perforator near the proximal pisiform bone before the operation. During the operation, the DUAP flap started to be elevated from the radial side; however, during perforator dissection, it was found that no ulnar artery was near the ulnar nerve and no axial artery was attached to the perforator.…”

Section: Discussionmentioning

confidence: 55%

“…Although their pedicle diameters (0.9-1.4 mm) are compatible with the digital artery, their pedicle lengths may be too short in some cases. 11 Comitant veins or superficial veins can be used in vein anastomosis. If the palmar cutaneous branch of the median nerve is included, it becomes a sensory flap.…”

Section: Discussionmentioning

confidence: 99%

“…If the palmar cutaneous branch of the median nerve is included, it becomes a sensory flap. 11 Palmaris longus may be included in the flap in tendon defects. 11 In cases with short proximal pedicle length, a flow-through SPBRA flap can be designed.…”

Section: Discussionmentioning

confidence: 99%

“…11 Palmaris longus may be included in the flap in tendon defects. 11 In cases with short proximal pedicle length, a flow-through SPBRA flap can be designed. 22 The pedicle distal to the flap is dissected until its junction with the superficial arch can be elevated reversely.…”

Section: Discussionmentioning

confidence: 99%

“…Also, since they are axial flaps, they are easier to dissect than perforator flaps. 11 In this study, we present a 34-year-old male patient who was scheduled to receive a free DUAP flap to repair the volar defect on the second finger of his right hand, but instead received a free SPBRA flap because the absence of an ulnar artery was observed during operation.…”

mentioning

confidence: 99%

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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?

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Uslu

Erdem

et al. 2021

Journal of Reconstructive Microsurgery Open

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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.

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

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?

Tatar

Uslu

Erdem

et al. 2021

Journal of Reconstructive Microsurgery Open

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

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Erçin

2023

Ann Plast Surg

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Background Volar finger defects can sometimes be challenging for plastic surgeons. There are many reconstruction options from local flaps to free flaps. Therefore, the aim of this study was to present a functional and cosmetic comparison of the results of using dorsoulnar artery perforator (DUAP), superficial palmar branch of the radial artery (SPBRA), and superficial circumflex iliac artery perforator (SCIP) flaps for repairing volar finger defects. Methods Thirty-two patients were included in the study. The age and sex of the patients, cause of injury, defect location, defect size, and presence or absence of nerve damage were noted. The patients' defects were reconstructed with DUAP, SCIP, or SPBRA flaps. The flap size, flap elevation time, vessels, and early postoperative complications were noted. During the postoperative follow-up period, the Michigan Hand Outcomes Questionnaire scale was used to evaluate hand function, and the modified Vancouver Scar Scale was used to assess aesthetic appearance. Two-point discrimination tests and cold intolerance tests were performed to measure sensory outcomes. Donor site improvements were also noted. Results There was no significant difference between the groups in terms of age, defect size, flap size, follow-up time, and 2-point discrimination. It was observed that the elevation time was significantly shorter in the SCIP flap group, and the Michigan Hand Outcomes Questionnaire score was significantly lower in the DUAP flap group compared with the other 2 groups (P < 0.01). In addition, the modified Vancouver Scar Scale score was significantly higher in the DUAP flap group (P < 0.01). Conclusion The findings of this study show that the use of SPBRA flaps has more advantages than the use of DUAP and SCIP flaps in many respects.

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Finger defect reconstruction using the radial artery superficial palmar branch free flap

Chi,

Heo,

Whang

et al. 2023

Arch Hand Microsurg

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Purpose: The radial artery superficial palmar branch (RASP) free flap is accepted as a surgical technique for the reconstruction of finger defects. This study revisited the RASP free flap and evaluated its reliability and usefulness in a variety of finger defects.Methods: From January 2017 to December 2022, multiple surgeons at a single institution performed a total of 315 RASP free flap reconstructions. Basic patient demographics and information on the finger defect and flap were assessed, and immediate postoperative flap and donor site-related complications were also studied. Data regarding long-term outcomes, such as the thumb joint range of motion and static two-point discrimination (S2PD), were collected and evaluated to identify statistically significant differences from the unaffected or non-innervated side. Results: The mean postoperative follow-up was 14.8 months. The total flap survival rate was approximately 91.4%. There was no statistically significant difference in mean postoperative palmar abduction and radial abduction between the affected and unaffected thumbs in both groups. In the single-digit group, there was a statistically significant difference in S2PD between the innervated flap and unaffected side. A statistically significant difference was also found between innervated and non-innervated flaps in the multiple-digits group. Conclusion: The RASP free flap is a valuable surgical option in reconstructing finger defects. It has already been proven to be safe and useful in coverage of single and tip defects. Stability should be ensured when there are multiple defects. Finally, the donor site morbidity is minimal and the recovery of sensation, once the flap is reinnervated, could be promising.

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Reconstruction of finger composite defects with perforator free flap from the superficial palmar branch of radial artery

Cited by 3 publications

References 0 publications

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?

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?

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

Finger defect reconstruction using the radial artery superficial palmar branch free flap

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