Hand Perforators: An Anatomical Study

Perforator flaps, now used in various parts of the body, serve as a crucial option for the reconstruction of defects in the hand region, often caused by tumor resections, trauma, or burns. Understanding the anatomy of hand perforators allows for the design of flaps closer to the defect, improving tissue compatibility without requiring the sacrifice of major arteries.

The study was conducted on 22 hands from 11 cadavers fixed in a 10% formaldehyde solution. The radial and ulnar arteries were dissected in the distal third of the forearm. Following cannulation, dyed latex solution was injected into each artery. During the dissection, skin perforators were measured with a digital micrometer, and the exit points were recorded.

At least 1 perforator vessel was found in every palmar subregion examined during cadaver dissections. The proximal hypothenar region, distal thenar region, and midpalmar region allow for the design of safe, defect-adjacent flaps with more perforators compared with other palmar regions. On the dorsal side, the middle part of the dorsum had the fewest perforators; in some hands, no perforators were found in this region.

This study details the anatomy of skin cutaneous perforators of the hand. Knowing the perforator anatomy of the hand enables surgeons to design flaps of appropriate location and size for the defect, achieving maximum surgical benefit with minimal morbidity.