Vascular Anatomy and Clinical Application of the Free Proximal Ulnar Artery Perforator Flaps

Abstract

Background:There is a dearth of detailed published work on the anatomy of ulnar artery perforators. The objective of this study was to fully document the vascular basis of the free proximal ulnar artery perforator flap and report its use in reconstruction of the hand.Methods:(1) The ulnar artery perforators were studied in 25 fresh cadavers and 10 cast preparations. Cadavers were injected with lead oxide for 3-dimensional reconstruction. The origin, course, and distribution of the ulnar artery perforators were comprehensively documented. (2) Between August 2011 and January 2013, 29 free proximal ulnar artery perforator flaps were utilized for reconstruction of soft-tissue defects of the hand in 25 patients. Flap size varied from 3.5 × 2.0 cm to 24.0 × 4.0 cm, with a consistent thickness of approximately 3 mm.Results:(1) There were 7 ± 2.0 ulnar artery perforators. The average external diameter was 0.6 ± 0.2 mm. Each perforator supplied an average area of 26 ± 7.0 cm2. Extensive anastomoses were found between the ulnar artery perforators and multiple adjacent source arteries. (2) All flaps survived. The clinical results were satisfactory after 10.2 ± 5.3 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors.Conclusions:The main advantage of the proximal ulnar artery perforator flap is that it is a thin flap that is ideal for upper extremity reconstruction, either as proximally or distally based local perforator flap or as a free flap. The donor site is excellent, and the vascular anatomy is very consistent.

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

“…According to literature in this area, it is possible to harvest flaps with a maximum width of 5 cm to be able to achieve direct closure of the donor site. 16 In our case series, we always attained direct closure of the donor site with a scar located more proximally and ulnarly with respect to usual ulnar artery perforator flaps harvest. This position is considered less visible in the typical posture of the upper limb, for example, when shaking hands or walking.…”

“…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.…”

“…31 We agree with sever authors stating that proximal forearm represents a high quality, less hirsute skin area, allowing the harvest of thin flaps. 3,16 The thickness of the flap is a major concern in hand reconstruction. Due to the specific characteristics and functions of the hand, flaps used in these cases have to be as thin as possible to avoid bulkiness.…”

“…15 Wei et al in 2014 documented the three-dimensional anatomy of the proximal ulnar artery perforators and their application in proximally based perforator flaps based on the ulnar recurrent arteries. 16 They concluded that these flaps show a reliable blood supply with good texture and thickness, useful for repairing soft-tissue defects. 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 from the perforators originating from the PURA, to spare both the main axis of vascular supply to the hand.…”

Identification of Ulnar Artery Perforators Using Color Doppler Ultrasonography

“…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).…”