Transverse Ulnar Forearm Flap

Abstract

The transverse ulnar forearm flap (TUFF) was used to reconstruct different recipient sites in 5 consecutive cases based on the specific requirement for a small thin, hairless flap with a long pedicle. Recent studies have clarified the benefits of the ulnar forearm flap: a less inconspicuous donor site and a primary donor site closure with a radially based fasciocutaneous flap. The TUFF is designed with its long axis transverse and distal margin parallel with a wrist flexion crease. An incision is extended proximally along the ulnar artery pedicle as far as the takeoff from the brachial artery if needed. After elevating the ulnar forearm flap in the standard fashion, transverse primary closure of the donor site is obtained by elevating a large volar forearm fasciocutaneous flap based on the radial artery and advanced distally with a V-Y advancement. Any dog ear is tailored, and the wrist is flexed at 30 degrees. All TUFF and radial fasciocutaneous flaps survived completely without partial or total losses or ischemic hand complications. One patient had a wide scar at the proximal forearm Y junction that was revised. Two-point fingertip discrimination and range of motion were satisfactory. The TUFF is a synthesis of variations of previously described forearm flap techniques and provides a specialized flap in situations where small, thin, pliable, hairless fasciocutaneous flap with a long vascular pedicle are necessary. These characteristics make it appropriate in orbital reconstruction and palatal surgery.