Patient-specific 3D-printed perforator mapping guide for propeller flap reconstruction in the hand

Reconstruction of hand soft tissue defects relies on accurate perforator localization, yet conventional planning with computed tomography angiography or handheld Doppler requires mental three-dimensional (3D) translation, and is associated with mapping errors or intraoperative adjustments. This article evaluates the use of an innovative patient-specific, surface-conforming 3D-printed guides that convert segmented preoperative magnetic resonance imaging (MRI) data into tangible templates to project dorsal metacarpal artery (DMA) perforator emergence points onto the skin with reproducible accuracy. In an illustrative case, a 66-year-old man underwent wide local excision of a digital porocarcinoma followed by propeller flap reconstruction. The third and fourth DMA perforators were identified from MRI, with a 2 mm-thick dorsal hand shell designed with 1 cm fenestrations corresponding to perforator emergence points. The perforators were marked onto the skin through the custom guide preoperatively, with skin markings cross verified with handheld Doppler. Reconstruction proceeded using a fourth DMA perforator-based propeller flap rotated to achieve tension-free coverage, with complete flap survival and restoration of full digital motion and satisfactory aesthetics. The 3D-printed guide reduced cognitive load, accelerated perforator localization, and minimized unnecessary dissection, supporting shorter tourniquet duration and safer elevation. The hand's distinct bony landmarks and stable contours enable reliable registration of rigid surface guides. As costs and workflows for imaging-to-print continue to decrease, patient-specific 3D-printed guides represent a practical, scalable adjunct that improved accuracy, efficiency, and reproducibility in perforator-based hand reconstruction.