Introduction: Reconstruction of complex wounds in the upper limbs is a difficult task as multiple structures, including nerves, blood vessels and tendons are arranged in a relatively small soft tissue envelope with limited options available for reconstruction. Early dtection and proper mangemnt of vascular compromise of perforator flaps is key for success of these reconstructive surgeries.Aim: Evaluating of perferator flaps to cover upper limbs wounds.Patients and Methods: Twenty-four cases were included in this study. After wound debridement, fasciocutaneous flaps nourished by perforator vessels were used for coverage in these patients. All patients were followed-up for at least 12 months.Results: Twenty-three patients were males, and one patient was female. The age ranged from 9 to 55 years. All flaps survived completely except one flap which showed partial necrosis. Within 12 hours after surgery, temporary venous congestion was observed in 2 cases. Conservative measures could resolve venous congestion with flaps' survival. Followup showed excellent contour of the flaps with stable coverage. Regional perforator flaps included in this study was radial artery perforator flaps (8 cases), ulnar artery perforator flaps (6 cases), posterior interosseous artery perforator flaps (8 cases) and lateral arm flap (one case). Conclusion:Perforator based flaps provide stable wound coverage with low cost and low morbidity rate for coverage of complex wounds in the upper limb. Careful and meticulous technique and early detection of venous congestion is critical for survival of these flaps.

Background: The anterolateral thigh (ALT) flap is a versitile perforator flap. It can be used as a pedicled flap, a reverse flow flap or a free flap. However, thoroug understanding of the anatomic variations of the vascular pedicle of this flap is important for successful flap elevation.Aim: Presenting a case of unusual venous drainge of reverse-flow unterolateral thigh flap. Methods:We report a cases of reverse-flow (ALT) flap with anatomic variation of its venous outflow. During flap elevation, an anomolous vein was found in the intermusclar septum between the vastus lateralis and vastus intermedias muscles. Temporary occlusion of this vein resulted in intraoperative flap congestion. So, we dicided to include this vein with the flap. The flap had two venous systems. The first venous system was the vena comitantes of the descending branch of the lateral circumflex femoral vessles and the second was the anomolus vein which emerged from the vastus intermedius muscle.Results: Postoperative course was unenevtful and the flap survived completely. We did not observe any flap congestion or flap arterial insuficency. Complete wound healing was achieved in 3 weeks. Conclusions:We conclude that this anomolous vein has a significant contribution to the venous outflow of this flap. Meticulous planning and intaraoperative disection is needed for successful elevation of ALT flap.

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