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: Objective: Under the assumption that the ulnar artery is the predominant blood supply to the hand, radial forearm free flaps (RFFF) generally have been preferred over ulnar forearm free flaps (UFFF) in head and neck reconstruction. The objective of this study is to create the first and only systematic review of the literature regarding UFFF in head and neck reconstruction, assessing the usage, morbidity, complications, and rationale of its use. Methods: A systematic review of the literature was conducted using PubMed, including Mesh terms and manual searches. Articles not in English were excluded. Results: Seventeen articles of the 80 articles identified by our search criteria met inclusion criteria; a total of 682 cases of UFFF were identified, including our patient case. Fifty-five percent of the cases involved use of the Allen's test. Mean flap size was 6.1 × 10.5 cm. Of the 432 cases reporting flap survival, 14 (3.2%) flap losses were reported, 13 total (3.0%), and one partial (0.2%). The UFFF was preferred to the RFFF due to decreased hirsutism (61%), better cosmetic outcomes (91%), and better post-operative hand function with reduced donor site morbidity (73%). For the case report, an UFFF was used successfully for lid reconstruction and resurfacing in a 72-year-old man who presented with late ectropion and exposure keratopathy following maxillary resection for leiomyosarcoma. Conclusions: This is the first and only systematic review of the literature to date of UFFF in head and neck reconstruction. Our review demonstrates that the UFFF rarely results in flap loss, donor site morbidity, or hand ischemia, instead providing enhanced outcomes. With its many surgeon-perceived advantages and minimal morbidity, the UFFF may become a preferred forearm flap for head and neck reconstruction. © 2013 Wiley Periodicals, Inc. Microsurgery, 2013.
    Microsurgery 07/2013; · 1.62 Impact Factor
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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.
    Head & Neck 12/2013; · 2.83 Impact Factor
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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.
    Plastic and reconstructive surgery. Global open. 07/2014; 2(7):e179.