Dorsal Ulnar Artery Research Articles

Dorsal Ulnar Artery Flap

Dorsal Ulnar Artery Flap

Reconstruction of Hand Soft-Tissue Defects: Alternatives to the Radial Forearm Fasciocutaneous Flap

Soft-tissue defects of the hand and wrist are not an uncommon problem confronting the hand surgeon. Over the past 20 years the retrograde radial forearm fasciocutaneous flap has gained widespread acceptance in reconstruction of these defects. Appreciation of the inherent limitations of this workhorse flap and increased understanding of the blood supply of the upper extremity have prompted the development of several alternative pedicled forearm flaps. Aspects of surgical technique, specific limitations, and indications for the radial forearm fascial flap, the posterior interosseous artery flap, the retrograde radial artery perforator flap, and the dorsal ulnar artery flap are discussed and a reconstructive algorithm for flap selection is presented.

Osteofasciocutaneous flap based on the dorsal ulnar artery. A new option for reconstruction of composite hand defects

Since the initial description of the dorsal ulnar artery fasciocutaneous flap by Becker and Gilbert in 1988 many modifications have been introduced to allow more versatility to the flap. The authors describe the dissection technique of an osteofasciocutaneous flap based on the dorsal ulnar artery and present a clinical case where this flap has been used to reconstruct a bone defect of the fifth metacarpal.Up to one third of the outer cortex of a long bone is supplied by the periosteal arterioles. This permits the inclusion of a small amount of ulnar cortical bone in the dorsal ulnar flap to reconstruct compound defects of the hand.The essential precaution is not to disrupt the continuity formed by the posterior border of the ulna, the periosteum, bony attachments of the flexor carpi ulnaris and extensor carpi ulnaris muscles, fascia and the skin. This flap allows the transposition of optimal soft tissue coverage to the hand with vascularised bone preserving the main arteries to the hand.

Our experience with the use of the dorsal ulnar artery flap in hand and wristtissue cover

We describe a series of six cases exploring the limits of reliability of the dorsal ulnar artery fasciocutaneous flap as described by Becker and Gilbert (1988a; b). Although the territory supplied by the dorsal ulnar artery is 10 cm to 20 cm long by 5 cm to 9 cm wide, Becker and Gilbert suggested that flaps should be confined to smaller dimensions. We have found that larger flaps (15 to 20 cm long and 5 to 8 cm wide) are feasible, extending the use of the flap to the radial side of the wrist and hand. However, problems were encountered with venous drainage and these larger flaps should be used with caution.

The ulnar flap ? Description and applications

A new skin or fascial flap has been described, based on the dorsal ulnar artery. This constant vessel on 100 fresh forearms, with a diameter of 1 to 1.3 mm, passes under the flexor carpi ulnaris muscle. It ensures the vascularization of the skin and the aponeurotic fascia on the distal two-thirds of the ulnar side of the forearm (1:9 to 20 cm; 1:5 to 10 cm). A flap described to cover defects of the dorsal and palmar aspects of the hand and wrist, the thenar and hypothenar eminences. The aponeurotic flap is used to avoid fibrosis around the median nerve and the tendons. The authors present an anatomical study and some clinical applications.

Le lambeau cubital

The authors describe a flap with a pedicle derived from the dorsal branch of the ulnar artery. The ulnar artery gives rise to the dorsal ulnar artery 2 to 5 cm before the pisiform. This artery passes under the flexor carpi ulnaris muscle, accompanied by the dorsal branch of the ulnar nerve. It supplies an area 10 to 20 cm long by 5 to 9 cm wide on the ulnar side of the forearm and it also supplies the skin lying over the last three metacarpals on the dorsum of the hand and the Vth abductor. This artery also sends a branch to flexor carpi ulnaris and to the pisiform. It is now possible to trace a large flap in the forearm without interrupting the arterial axis. Large defects of the dorsum of the hand, wrist, thenar and hypothenar eminences can be covered by this pedicle or island flap. This artery is remarkably constant. Five clinical cases are presented.