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: 2.99).
09/2011; 129(1):213-20. DOI: 10.1097/PRS.0b013e3182362a9c
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.
Available from: Sammy Al-Benna
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ABSTRACT: Background: The radial forearm free flap (RFFF) is the most commonly used free flap in head and neck reconstructive surgery. However, despite excellent results with respect to the site of reconstruction, donor site morbidity cannot be neglected. This review summarizes the current state of knowledge and analyzes the level of evidence with regard to perioperative management of the reduction of RFFF donor site morbidity. Methods: The medical Internet source PubMed was screened for relevant articles. All relevant articles were tabulated according to the levels of scientific evidence, and the available methods for reduction of donor site morbidity are discussed. Results: Classification into levels of evidence reveals 3 publications (1.5%) with level I (randomized controlled trials), 29 (14.0%) with level II (experimental studies with no randomization, cohort studies, or outcome research), 3 (1.5%) with level III (systematic review of case-control studies or individual case-control studies), 121 (58.7%) with level IV (nonexperimental studies, such as cross-sectional trials, case series, case reports), and 15 (7.3%) with level V (narrative review or expert opinion without explicit critical appraisal). Thirty-five (17.0%) articles could not be classified, because they focused on a topic other than donor site morbidity of the RFFF. Conclusions: Although great interest has been expressed with regard to reducing the donor site morbidity of the workhorse flap in microvascular reconstruction procedures, most publications fail to provide the hard facts and solid evidence characteristic of high-quality research.
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The objective of this study was to provide anatomical information for the repair of small tissue defects in the hands and forearms with ulnar artery pedicle cutaneous branches-chain perforator flaps.
Twelve ulnar artery pedicle cutaneous branches-chain perforator flaps taken from human cadavers were studied using three methods: latex perfusion for microanatomy analysis, denture material and vinyl chloride mixed packing for cast analysis, and polyvinyl alcohol and bismuth oxide perfusion for molybdenum target x-ray arteriography. Statistical analysis was performed on cutaneous perforators with a diameter of 0.2 mm or greater. Cluster analysis was conducted to determine the overall distribution of perforators.
There are two main clusters of perforators at a relative distance of 22.34 percent and 58.73 percent along the pisiform bone to the medial epicondyle. Two thick cutaneous perforators extend through the flexor digitorum superficialis and the flexor carpi ulnaris muscle gap, which are located 4.57 ± 0.59 cm proximal to the pisiform bone and 7.73 ± 1.14 cm distal to the medial epicondyle, with diameters of 0.63 ± 0.09 and 0.75 ± 0.15 mm and pedicle lengths of 1.49 ± 0.34 and 1.46 ± 0.54 cm. At the two main clusters of perforator-intensive sites, vessel chains formed by adjacent perforators were parallel to the flexor digitorum superficialis and the flexor carpi ulnaris muscle gap.
This study demonstrated that the ulnar artery has two main clusters of perforators in the proximal one-third and distal one-fourth of the forearm, which can be used for ulnar artery pedicle cutaneous branches-chain perforator flaps to repair hand and forearm parenchymal defects.
Available from: Swee T Tan
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