Clinical study of dorsal ulnar artery flap in hand reconstruction

Abstract

Soft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.

Use of Dorsal Ulnar Artery Flap for Coverage of Arterio-Cutaneous Fistula over Post-Electrical Burn Scar: A Case Report

“…Other preferred options include posterior interosseous artery (PIA) flap, which does not compromise the major vessels; but it is a time consuming procedure and needs more expertise in comparison to perforator based flaps of radial or ulnar artery. 2,5 Distal flaps (e.g. groin flap) result in immobilization of the hand for long periods.…”

“…The dorsal ulnar artery fasciocutaneous flap can be raised as a hinge (peninsular), or as a true island flap. 2 Here, we are presenting a case report, where the dorsal ulnar artery flap was used to cover the arterio-cutaneous fistula over the post electrical burn scar in a 38 years old male over the left wrist.…”

Distally based ulnar artery perforator flap for hand reconstruction and wrist defect closure

“…Its advantages are that it is a safe, simple, and effective 1-stage procedure that provides thin, pliable, good-quality skin with a robust blood supply. 2,8 The main disadvantages are donor site morbidity and the short pedicle, which results in a relatively limited arc of rotation, 1,7,8 but this tends to mature well with time unless there is loss of the skin graft.…”

“…They also allow the patient freedom for occupational therapy to be commenced early. 5,8 Among the local flaps are the reverse radial island flap, reverse ulna island flap, and distally based ulnar artery perforator flap. The disadvantage of the reverse ulnar and radial artery island flaps is that they sacrifice the vascular supply to the hand.…”

The Importance of Dorsoulnar Flap in The Thumb’s Pulp Reconstruction - A Case Report and a Review of the Literature

“…The skin is first marked as follows (Figure 2) the dorsal arcade of the proximal nail fold (at 0.9 cm proximal to the cuticle), the palmar anastomosis at the level of the neck of the first phalanx (2.5 cm proximal to the cuticle), and the dorsoulnar collateral artery at the level of the neck of the first phalanx from the median axis of the thumb) [1]. The subcutaneous flap pedicle area (that will be raised with the flap) is also marked on the skin.…”