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.
Keywords
proximal ulnar artery perforator flap - hand reconstruction - posterior ulnar recurrent
artery
