Treatment of complex hand trauma using the distal ulnar and radial artery perforator-based flaps

The clinical value of distal ulnar or radial artery adipofascial perforator flaps is shown in a series of 30 patients with severe hand and wrist injuries and major soft tissue defects requiring coverage. There were 22 men and 8 women, aged 16-73 years. The defects were dorsal and/or palmar, with or without transpalmar or transcarpal amputation, or amputation of the thumb and/or the digits. Tendon injuries have been treated primarily or secondarily, or reconstructed using silicon rods. In all cases, after surgical debridement of the wound, reconstruction of the defect was done using distal ulnar (21 patients, in 3 patients primary reconstruction) and distal radial artery (11 patients; in 2 patients primary reconstruction and in 2 patients after necrosis of distal ulnar perforator flap) adipofascial perforator flaps. Minimum follow-up was 6 months. Two ulnar flap showed partial necrosis and were revised successfully by distal radial adipofascial perforator flaps. One radial and one ulnar flap showed 50% and 60% necrosis, respectively, and were revised by groin flaps. All donor sites healed uneventfully. Functional and cosmetic result was very good in 15 patients and good or satisfactory in the remaining. Range of motion of the wrist and hand joints was almost within normal limits (less than 25 degrees extension or flexion deficits). Distal ulnar and radial artery adipofascial perforator flaps for traumatic defects of the hand and wrist offer several advantages compared to other local flaps; they are easy to obtain and cover effectively both dorsal and palmar defects without significant functional deficits or donor site complications to the upper limb.