[Simple and composite ulnar transplants in reconstructive surgery of the hand]

Over several years, the authors have devised a technique for compound island transplants of ulnar origin, harvested from the forearm's lower third, with reverse flow vascularization. Because of the variety of arterial ramifications, these transplants can consist: either of a simple cutaneous, superficial flexor tendon or ulnar fragment transplant, or, when associated, of compound cutaneous-tendinous, cutaneous-osseous and even cutaneous-tendinous-osseous transplants. These transplants, based on the clinical experience of 192 cases, can be used by retrograde rotation for a variety of indications, such as loss of skin cover, digital surface reconstruction or treatment of scaphoid pseudoarthrosis. But their main indication, as it represents a basic difference with other retrograde flaps, is the possibility of an island transplant of several superficial flexors complete with sheats, for the reconstruction of the fingers' flexing system in a single surgical act. This is all the more interesting as it is still technically possible to combine it with a cutaneous flap, so that the tendinous and cutaneous problems can be solved simultaneously. This technique permits reconstruction of the fingers' flexor system based on another concept, i.e. by using a vascularized tendinous transplant, and under different conditions since a single surgical act is required, thus saving long periods of sick leave, with functional results which compare with those of traditional techniques.