The ulnar palmar perforator flap: Anatomical study and clinical application

Abstract

Defects sustained at the little finger and the ulnar aspect of the hand are common and pedicled perforator flaps have unique advantages in resurfacing it. The purpose of this study is to reappraise the anatomy of the septocutaneous perforator in the postero-medial aspect of the hand and present our clinical experience in using perforator flaps based on it. This study was divided into anatomical study and clinical application. In the anatomical study, 30 preserved upper limbs were used. Clinically, 16 patients with defects at the little finger or the ulnar aspect of the hand underwent reconstruction with flaps based on the perforator from the ulnar palmar artery of little finger. The defects ranged from 2.3 × 1.3 cm(2) to 5.7 × 3.0 cm(2). The septocutaneous perforator was constantly located 1.3 ± 0.3 cm superior to the fifth metacarpophalangeal joint with a diameter of 0.8 ± 0.2 mm. It travelled through the space between the superficial layer and the deep layer of hypothenar muscles, and ramified into three branches before entry into the skin. The ascending branch of the perforator has two patterns of anastomoses with the descending dorsal carpal branch of the ulnar artery: true anastomoses and choked anastomoses. Clinically, flaps in all 16 cases survived uneventfully, and donor sites healed without deformity. The location of the perforator at the postero-medial aspect of the hand is consistent; the ulnar palmar perforator flap is particularly suitable to cover defects in the little finger or the ulnar aspect of hand.