Identification of Ulnar Artery Perforators Using Color Doppler Ultrasonography

Abstract

Background The ulnar artery perforator (UAP) flap, which is hairless, thin, and pliable, has been used for the reconstruction of soft tissues from the finger to the elbow. Preoperative planning is essential for a perforator flap surgery, and there are some tests to identify perforators. Color Doppler ultrasonography (US) with a high-frequency transducer helps in detecting decreased flow in smaller vessels, such as perforators. The purpose of this study was to determine the anatomical locations and origins of perforators arising from the ulnar artery using color Doppler US in healthy volunteers. Methods Forty forearms of 20 healthy volunteers were included in the study. Perforators arising from the ulnar artery, within 100 mm proximal to the pisiform, were investigated using color Doppler US with a high-frequency transducer. Results A total of 205 perforators were identified. On comparing the locations in each 20 mm section from the pisiform, the largest number of perforators was 58 (28%), within 20 mm proximal to the pisiform. The axial view demonstrated 44 (21%), 64 (31%), 32 (16%), and 65 (32%) perforators in the radial, ulnar, superficial, and deep aspects of the ulnar artery, respectively. Fifty-two and 28 essential perforators were supplied by the UAPs arising from the superficial and ulnar aspect within 20 mm proximal to the pisiform and between 21 and 40 mm proximal to the pisiform, respectively, while elevating the UAP flap. Conclusion This is the first study to assess the UAP using color Doppler US. Identification of UAP using color Doppler US can be used as a preoperative assessment for reliable elevation of a UAP flap.

Ulnar Artery Perforator Adiposal Flap for Paraffinoma Treatment in a Patient With Leprosy: A Case Report

“…The preoperative ultrasound was used in this case to seek for the perforator. 8,10 In the treatment of the present patient, filling the dead space with tissue with sufficient blood flow was necessary for infection control and conditioning. The UAP adiposal flap was considered as it had reliable blood flow and enough tissue volume to fill the defect.…”

“…7 Moreover, the perforator adiposal flap provided sufficient blood flow to the transfer site. 8 Thus, performing a split-thickness skin graft after covering the defect with a perforator adiposal flap is possible. Other options that were considered are the radial artery perforator (RAP) or dorsal metacarpal artery perforator adiposal flaps.…”

Mapping 216 Perforator Flaps Using Highly Portable Tablet-Based Color Doppler Ultrasound (PT-CDU)

“…19 Ishiko et al, used color Doppler ultrasound to precisely locate perforators relative to the pisiform bone for the hairless, thin, and pliable ulnar artery perforator flap. 20 Cho et al, discussed the customization that can be achieved, including in the areas of supermicrosurgery, superthin flaps, and perforator-to-perforator anastomoses. 21…”

Expanding the Armamentarium of Donor Sites in Microvascular Head and Neck Reconstruction

“…Alternatively, the flap can be harvested as a perforator flap which has also been proven to be extremely reliable. The ulnar artery perforator (UAP) flap is harvested more proximally than its fasciocutaneous counterpart since the perforators arise more proximally [ 8 , 9 ]. The distal extent of the flap is typically oriented approximately five centimeters proximal to the pisiform along an axis from the pisiform to the medial epicondyle ( Figure 1 ).…”