Distal radial and ulnar arteries perforator-based adipofascial flaps for covering hand traumatic defects

The clinical value of adipofascial flaps based on distal ulnar or radial-artery perforators is demonstrated in a series of 14 patients with severe hand injuries and significant soft tissue defects requiring coverage.

There were 10 male and 4 female patients, aged between 23 and 72 years. The defects were 7 dorsal, 4 palmar, 1 combined dorsal-palmar, and 2 with thumb or total digit amputation. In the patients with a dorsal defect, the extensor tendons were intact in 2 cases, reconstructed in 2 cases, and reconstructed in 3 cases using silicon rods. Following debridement, a fascial flap based on a distal ulnar (12) or radial (4, 2 primarily and 2 secondarily) artery perforator was fashioned and used to cover the defect. A split thickness skin graft was used to cover the defect and the hand was immobilized for 2 weeks.

All cases were followed up for at least 6 months. The donor and recipient sites healed uneventfully, and the functional result was very good in terms of wrist and hand joint range of motion, which approximated the normal rates. The extension or flexion deficit was less than 25 degrees. The esthetic result was satisfactory. Two ulnar flap partial (involving approximately 35% of the area) necroses have been treated using reversed radial-distal perforator flaps.

The described fascial flaps offer several advantages over other local flaps, and are rather easy to perform and cover effectively both dorsal and palmar hand defects without causing significant functional deficits to the upper limb.