The Proximal Fasciocutaneous Hypothenar Flap Based on the Cutaneous Branch of the Deep Palmar Artery: A Case Report

Abstract

The abductor digiti quinti flap for thumb hypoplasia has been used in its muscular variant as musculocutaneous flap. Several authors have reported myocutaneous branches in the proximal hypothenar region which would vascularize the skin segment covering the hypothenar muscles. Nevertheless, the presence of a cutaneous branch deep palmar artery (CBDPA) vascularizing the proximal hypothenar territory and possibly responsible for the proximal hypothenar cutaneous vascularization was reported. In this paper, a fasciocutaneous hypothenar flap was designed, based on the CBDPA, transposed to the wrist anterior region for the treatment of a post burn contracture which was limiting the wrist extension. Its viability was assessed. The flap had a lozenge-shaped design from the cutaneous fold of the wrist to the fifth metacarpophalangeal joint over the abductor digiti quinti muscle. It was dissected in the fasciocutaneous plane to a width of 20 mm. The adipose tissue zone 10 mm distal to the pisiform was preserved, as well as the ulnar nerve sensory branch crossing the flap longitudinally. The flap was transposed to the anterior fold of the wrist. Neither the flap nor the donor site underwent complications. The patient improved wrist extension without referring any discomfort. Sensitivity was 8 mm 2 months after surgery compared to 6 mm within the preoperative period. In conclusion, it is possible to develop a proximal fasciocutaneous hypothenar flap based on CBDPA involving the proximal and distal hypothenar territory.

Cutaneous Perforators and Their Clinical Implications on Intrinsic Hand Flaps: A Systematic Review

“…Areas covered by several different-colored ellipses stacking on top of each other have a higher chance of having cutaneous perforators, as proven by several studies. To depict the location of perforators into this figure, an estimated length of 46, 68, 64, 58, and 53 mm for the first, second, third, fourth, and fifth metacarpus (Buryanov & Kotiuk 67 ) was used, respectively.…”

“…There were 62 cases of hypothenar flaps, all of which survived except for one free skin flap, which had partial loss due to venous congestion. Two studies 37,42 achieved sensate flaps with 2PD of 5.7-8 mm. Almost all studies did direct closure on donor sites, split thickness skin graft, or full thickness skin graft when necessary, and one study 28 closed their donor areas strictly with full thickness skin grafts.…”