Anatomical Study and Clinical Application of Ulnar Artery Proximal Perforator FlapsFunding None.
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.
Keywordsproximal ulnar artery perforator flap - hand reconstruction - posterior ulnar recurrent artery
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.
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.
Received: 29 April 2020
Accepted: 15 July 2020
01 September 2020 (online)
Thieme Medical Publishers
333 Seventh Avenue, New York, NY 10001, USA.
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