Perforator Patterns of the Ulnar Artery Perforator Flap

Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Plastic and Reconstructive Surgery (Impact Factor: 3.33). 09/2011; 129(1):213-20. DOI: 10.1097/PRS.0b013e3182362a9c
Source: PubMed

ABSTRACT Flaps based on the ulnar artery have never gained the same popularity as the radial forearm flap, despite several potential advantages. In this article, the authors describe a true ulnar artery perforator flap with perforator mapping.
Thirty-eight consecutive patients who underwent ulnar artery perforator flap surgery were included in the study. The size, number, and location of perforators were recorded intraoperatively. Preoperative and postoperative grip strength was tested and compared.
One to three cutaneous perforators from the ulnar artery were identified and designated as A, B, and C from distal to proximal. Perforator A was present in 79 percent of cases and located 7.3 ± 1.1 cm from the pisiform. Perforator B was present in 95 percent of cases and located 11.4 ± 1.0 cm from the pisiform. Perforator C was present in 87 percent of cases and located 15.9 ± 1.8 cm from the pisiform. All patients had at least two perforators, and 61 percent had three perforators. All flaps were used for head and neck reconstruction and all were successful. Donor-site morbidity was minor. Grip testing demonstrated a transient decrease in grip strength during the postoperative period, and most recovered to the contralateral level by 3 months.
At least two perforators are present in the ulnar artery perforator flap territory. This flap is reliable and easy to harvest and has minimal donor-site morbidity. It should be considered as an alternative to the radial forearm flap in select patients.

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    ABSTRACT: There is a dearth of detailed published work on the anatomy of ulnar artery perforators. The objective of this study was to fully document the vascular basis of the free proximal ulnar artery perforator flap and report its use in reconstruction of the hand. (1) The ulnar artery perforators were studied in 25 fresh cadavers and 10 cast preparations. Cadavers were injected with lead oxide for 3-dimensional reconstruction. The origin, course, and distribution of the ulnar artery perforators were comprehensively documented. (2) Between August 2011 and January 2013, 29 free proximal ulnar artery perforator flaps were utilized for reconstruction of soft-tissue defects of the hand in 25 patients. Flap size varied from 3.5 × 2.0 cm to 24.0 × 4.0 cm, with a consistent thickness of approximately 3 mm. (1) There were 7 ± 2.0 ulnar artery perforators. The average external diameter was 0.6 ± 0.2 mm. Each perforator supplied an average area of 26 ± 7.0 cm(2). Extensive anastomoses were found between the ulnar artery perforators and multiple adjacent source arteries. (2) All flaps survived. The clinical results were satisfactory after 10.2 ± 5.3 months of follow-up. The flaps were considered cosmetically acceptable by both patients and doctors. The main advantage of the proximal ulnar artery perforator flap is that it is a thin flap that is ideal for upper extremity reconstruction, either as proximally or distally based local perforator flap or as a free flap. The donor site is excellent, and the vascular anatomy is very consistent.
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    ABSTRACT: Background: The ulnar free forearm flap (UFFF) represents a variant of soft tissue transplants for orofacial reconstruction with specific topographic anatomy of the donor-site which has to be considered during flap raising. Methods: Analysis of intraoperative findings during harvest of 322 UFFF for head and neck reconstruction was performed. Harvest technique in view of variations of skin flap, vascular and neuronal anatomy is described and related literature is reviewed. Results: Aberrant superficial ulnar artery was observed in 1.5 % of cases. The Martin-Gruber anastomosis was seen in 11.5 %. The dorsal branch of the ulnar nerve was always visible and had to be dissected and separated under the flexor carpi ulnaris muscle and donor-site morbidity was low. Conclusions: Considering local anatomic features and variations the harvest of the UFFF is safe and survival rates are comparable with those of the radial forearm flap. Head Neck, 2013.
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    ABSTRACT: Superficial ulnar artery is a rare finding but shows significant surgical implications. Its thinness and pliability make this flap an excellent solution for soft tissue reconstruction, especially in the head and neck region.We hereby report a successful free superficial ulnar artery perforator forearm flap transfer for tongue reconstruction. A 64-year-old man presenting with a squamous cell carcinoma of the left tongue underwent a wide resection of the tumor, left radical neck dissection, and reconstruction of the tongue and the left tonsillar pillar with the mentioned flap. No complications were observed postoperatively. The flap survived completely; no recurrence at 6 months of follow-up was detected.Superficial ulnar artery perforator flap has shown to be a safe alternative to other free tissue flaps in specific forearm anatomic conditions.
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