J Reconstr Microsurg
DOI: 10.1055/s-0040-1716321
Original Article

Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator Flaps

Mario Cherubino
1  Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
,
2  Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of Sassari, Sassari, Italy
,
Tommaso Baroni
1  Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
,
3  Department of Plastic and Reconstructive Surgery, Sapienza University of Rome, Umberto I University Hospital, Rome, Italy
,
Luigi Losco
4  Plastic Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
,
Corrado Rubino
2  Department of Medical, Surgical and Experimental Sciences, Plastic Surgery Unit, University of Sassari, Sassari, Italy
,
Luigi Valdatta
1  Division of Plastic and Reconstructive Surgery, Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
› Author Affiliations
Funding None.

Abstract

Background 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 based on the perforators originating from the posterior ulnar recurrent artery (PURA), to spare both the main axis of vascular supply to the hand. In addition, we present a case series of five patients treated for soft tissue defects of the hand with free ulnar artery proximal perforator flaps.

Methods Ten specimens of anterior forearm were dissected in this study to register number and characteristics of ulnar perforators. The dissection was focused on the perforators originating from the larger branch of the ulnar artery, the PURA, at the proximal third of anteromedial forearm. The anatomical dissections were evaluated in relationship with clinical dissections performed during flap harvesting in five patients.

Results In three of the specimens dissected, the proximal perforator originated from the PURA, and in the other seven specimens, it originated directly from the ulnar artery. Five cases of reconstruction of the hand were performed with success using the free ulnar artery proximal perforator flap, and in two cases, the perforator from the PURA was found and it was possible to raise the flap based on this branch of the ulnar artery.

Conclusion The free ulnar artery proximal perforator flap can be harvested in two different manners for the same skin island of the forearm. When possible, harvesting it form the PURA allows lengthening of the pedicle. In our experience, this flap presents many advantages such as thinness and hairlessness; it allows preservation of the ulnar neurovascular bundle with an acceptable donor site morbidity. Level of evidence: IV.

Authors' Contributions

M.C. supported in study design, data collection, performance of surgery, manuscript preparation, and critical review. A.B. dedicated in study design, data collection, data analysis, manuscript preparation, and critical review. T.B. focused in study design, data collection, and critical review. G.D.T. performed study design, manuscript preparation, and critical review. L.L. contributed in study design, manuscript preparation, and critical review. C.R. helped in study design, data analysis, and critical review. L.V. cooperated in study design, data analysis, manuscript preparation, and critical review.


Note

This study was performed with respect to the ethical standards of the Declaration of Helsinki, as revised in Tokyo 2004. Informed consent to participate was obtained from patients. Consent for publication was obtained from the patients.




Publication History

Received: 29 April 2020

Accepted: 15 July 2020

Publication Date:
01 September 2020 (online)

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