Degloving injuries of the fingers represent a reconstructive challenge. Even if poorly described in literature, the proximal ulnar perforator flap (PUPF), based on perforator of the anterior ulnar recurrent artery or directly on a perforator branch of the ulnar artery, meets the requested criteria for the ideal coverage. We performed a cadaveric study in order to clarify the anatomical basis and vascularization of the PUPF flap. Eight injected upper limb specimens were dissected for this study: perforators were followed down to their origin and classified in terms of number, length, diameters and distances between their emergence and specific pre-determined landmarks as the medial humeral epicondyle. At least one ulnar perforator in the proximal third of the forearm was identified in all the specimens. In 50% of the upper limbs, the perforator branch came directly from the ulnar artery, while in the 87.5% a perforator branch came from the anterior recurrent ulnar artery; in 3 out of 8 cases both perforator branches were described. Mean lengths of the perforator branch were 57.9 mm and 44.3 mm, respectively and the mean diameters measured at their origin were 0.99 mm and 1.17 mm respectively. Our data illustrate the consistency of at least one perforator branch from the proximal third of the ulnar artery, most commonly coming from the anterior recurrent ulnar artery. Considering our results, the PUPF could be a good alternative to the classical free flaps for the resurfacing of the finger defects.

Background. Neurofibromatosis type 1 (NF1) is an autosomal dominantly inherited neurocutaneous disease caused by a mutation in the neurofibromin gene on chromosome 17q11.22. NF1 is a multisystem disease, and patients with this condition are at an increased risk of developing both benign and malignant tumors of the central and peripheral nervous systems. Although rare, NF can affect the genital tract, with the vulva being the most common site and involvement of the vagina, cervix, and ovaries being reported less frequently. Genital involvement often causes pain and psychological discomfort for patients, and surgical removal is the mainstay of treatment due to the large innervation of the area. Material and methods. This work describes the case of a 41-year-old patient with a known diagnosis of NF1 who presented with a large painful mass in the left labium majus. The mass was surgically treated with a modeling excision technique. Results. At the six-month follow-up visit, the patient reported being very satisfied with the results, and no complications were observed. Conclusions. Conservative modeling surgical excision appears to be the most appropriate technique for managing giant genital NF. This technique minimizes the risk of bleeding, restores correct anatomy and sexual function, and has a positive impact on the patient's psychological well-being.