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Updated: Jun 5, 2026

Vascularized Composite Hand Allograft Procurement and Preparation for Distal and Proximal Forearm Allotransplantation: A Stepwise Approach
Published on: May 23, 2025
[Reconstruction of phalangeal defect with free mesio-forearm flap based on perforator of ulnar artery]
1Department of Hand Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
Objective:
To discuss the therapeutic effect and clinical experience of a new technique of digital reconstruction with the free mesio-forearm flap based on perforator of ulnar artery.
Methods:
We marked the line from the pisiformis to the condylus medialis humeri as the axis of the flap. We used Doppler to detect the site of the mesio-forearm ulnar perforator which is usually 9-10 cm proximal to the condylus medialis humeri as center of the flap. We designed the flap that contained perforator artery with its accompanying vein of the ulnar artery and a superficial vein around the center spot along the axis of ulnar artery. The wound at donor site was sutured directly. Neurorrhaphy was not conducted in any cases.
Results:
From June 2005 to June 2009, all 12 flaps survived with good quality and aesthetic contour. And no necrosis occurred. We conducted 6-36 months follow-up, and the result was satisfactory. The function of the fingers was reserved. Two-point discrimination differed from 6 cm to 12 cm.
Conclusions:
The free ulnar perforator flap on mesio-forearm can repair digital defect with good therapeutic effect, leaving less morbidity at donor site.
