The ulnar palmar perforator flap: anatomical study and clinical application

Area of Science:

• Plastic Surgery
• Hand Surgery
• Anatomy

Background:

• Defects of the little finger and ulnar hand are common.
• Pedicled perforator flaps offer distinct advantages for reconstruction.
• Understanding the anatomy of specific perforators is crucial for flap design.

Purpose of the Study:

• To re-evaluate the anatomy of the septocutaneous perforator in the postero-medial hand.
• To present clinical outcomes using perforator flaps based on this vessel.
• To establish the utility of the ulnar palmar perforator flap in hand reconstruction.

Main Methods:

• Anatomical dissection of 30 preserved upper limbs.
• Clinical reconstruction in 16 patients with defects of the little finger or ulnar hand.
• Flap design utilized the perforator from the ulnar palmar artery of the little finger.

Main Results:

• The septocutaneous perforator was consistently located 1.3 cm superior to the fifth metacarpophalangeal joint (diameter 0.8 mm).
• The perforator traversed hypothenar muscles and branched before skin entry, with variable anastomoses.
• All 16 clinical cases demonstrated successful flap survival and uneventful donor site healing.

Conclusions:

• The postero-medial hand perforator location is reliable.
• The ulnar palmar perforator flap is a suitable option for defects on the little finger and ulnar hand.
• This flap provides a reliable method for hand defect reconstruction.