Paraumbilical perforator flap for soft tissue reconstruction of the forearm

Numerous flaps exist for coverage of injuries to the upper extremity, ranging from local, to regional, to free tissue transfer. The choice of flap is dependent on a variety of factors, including patient, functional needs, and depth of injury. The paraumbilical perforator (PUP) flap for upper extremity coverage can offer the benefits and versatility of pedicled and free flaps while avoiding some of the donor-site morbidity and risks of free tissue transfer. We report the indications and management of two clinical cases that exemplify PUP flap application. Technical points of flap harvest, inset, timing of pedicle division, and pertinent anatomy are discussed.