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J Reconstr Microsurg 2011; 27(9): 543-550
DOI: 10.1055/s-0031-1285986
© Thieme Medical Publishers

Finger Pulp Reconstruction with Free Dorsoulnar Artery Perforator (DUAP) Flap

Tekin Simsek1 , M. Sinan Engin1 , Ozan Aslan1 , Tale Neimetzade2 , Lutfi Eroglu1
  • 1Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun
  • 2Clinic of Plastic Surgery, Tokat State Hospital, Tokat, Turkey
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Publication History

Publication Date:
23 August 2011 (online)

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ABSTRACT

Finger pulp is a common site for hand injuries, and pulp reconstruction is significantly important for optimal handling and sensation. Ideal substitute must provide matching texture, tenacity, and slim subcutaneous fat. This article presents six cases in which fingertip and finger pulp reconstruction were performed via free dorsoulnar artery perforator (DUAP) flap. All flaps survived and all patients healed uneventfully without any complications by the end of at least 3 months follow-up. Free DUAP flap has proved to be a suitable substitute for pulp reconstruction with its thin structure, minimally morbid donor site which is also close to the trauma zone, and possibility for neurotization. It can be especially favorable when splitting the surgical team for a glabrous flap harvest from the foot is not possible.

KEYWORDS

Dorsoulnar artery - perforator flap - finger pulp - free flap - finger reconstruction

REFERENCES

  • 1 Ozaksar K, Toros T, Sügün T S, Bal E, Ademoğlu Y, Kaplan I. Reconstruction of finger pulp defects using homodigital dorsal middle phalangeal neurovascular advancement flap.  J Hand Surg Eur Vol. 2010;  35 (2) 125-129
    PubMedGoogle Scholar
  • 2 Teoh L C, Tay S C, Yong F C, Tan S H, Khoo D B. Heterodigital arterialized flaps for large finger wounds: results and indications.  Plast Reconstr Surg. 2003;  111 (6) 1905-1913
    CrossrefPubMedGoogle Scholar
  • 3 Adani R, Marcoccio I, Tarallo L, Fregni U. The reverse heterodigital neurovascular island flap for digital pulp reconstruction.  Tech Hand Up Extrem Surg. 2005;  9 (2) 91-95
    CrossrefPubMedGoogle Scholar
  • 4 Woon C Y, Lee J Y, Teoh L C. Resurfacing hemipulp losses of the thumb: the cross finger flap revisited: indications, technical refinements, outcomes, and long-term neurosensory recovery.  Ann Plast Surg. 2008;  61 (4) 385-391
    CrossrefPubMedGoogle Scholar
  • 5 Puhaindran M E, Paavilainen P, Tan D M, Peng Y P, Lim A Y. Dermal pocketing following distal finger replantation.  J Plast Reconstr Aesthet Surg. 2010;  63 (8) 1318-1322
    CrossrefPubMedGoogle Scholar
  • 6 Sassu P, Lin C H, Lin Y T, Lin C H. Fourteen cases of free thenar flap: a rare indication in digital reconstruction.  Ann Plast Surg. 2008;  60 (3) 260-266
    CrossrefPubMedGoogle Scholar
  • 7 Huang S H, Wu S H, Lai C H et al. Free medial plantar artery perforator flap for finger pulp reconstruction: report of a series of 10 cases.  Microsurgery. 2010;  30 (2) 118-124
    PubMedGoogle Scholar
  • 8 Pan Z H, Jiang P P, Wang J L. Posterior interosseous free flap for finger re-surfacing.  J Plast Reconstr Aesthet Surg. 2010;  63 (5) 832-837
    CrossrefPubMedGoogle Scholar
  • 9 Pelzer M, Sauerbier M, Germann G, Tränkle M. Free “kite” flap: a new flap for reconstruction of small hand defects.  J Reconstr Microsurg. 2004;  20 (5) 367-372
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Lee D C, Kim J S, Ki S H, Roh S Y, Yang J W, Chung K C. Partial second toe pulp free flap for fingertip reconstruction.  Plast Reconstr Surg. 2008;  121 (3) 899-907
    CrossrefPubMedGoogle Scholar
  • 11 Wong C H, Teoh L C, Lee J Y, Yam A K, Khoo D B, Yong F C. Free digital artery flap: an ideal flap for large finger defects in situations where local flaps are precluded.  Ann Plast Surg. 2008;  60 (3) 254-259
    CrossrefPubMedGoogle Scholar
  • 12 Ozkan O, Akyürek M, Coşkunfirat O K, Safak T, Ozgentaş H E. The free radial artery septal perforator vessel-based flap.  Plast Reconstr Surg. 2005;  115 (7) 2062-2069
    CrossrefPubMedGoogle Scholar
  • 13 Kushima H, Iwasawa M, Maruyama Y. Recovery of sensitivity in the hand after reconstruction with arterialised venous flaps.  Scand J Plast Reconstr Surg Hand Surg. 2002;  36 (6) 362-367
    CrossrefPubMedGoogle Scholar
  • 14 Iwasawa M, Ohtsuka Y, Kushima H, Kiyono M. Arterialized venous flaps from the thenar and hypothenar regions for repairing finger pulp tissue losses.  Plast Reconstr Surg. 1997;  99 (6) 1765-1770
    CrossrefPubMedGoogle Scholar
  • 15 Yang J W, Kim J S, Lee D C et al. The radial artery superficial palmar branch flap: a modified free thenar flap with constant innervation.  J Reconstr Microsurg. 2010;  26 (8) 529-538
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 Inada Y, Tamai S, Kawanishi K et al. Free dorsoulnar perforator flap transfers for the reconstruction of severely injured digits.  Plast Reconstr Surg. 2004;  114 (2) 411-420
    CrossrefPubMedGoogle Scholar
  • 17 Ulkur E, Uygur F, Karagöz H, Celiköz B. Use of free dorsoulnar perforator flap in the treatment of postburn contractures of the fingers.  Burns. 2006;  32 (6) 770-775
    CrossrefPubMedGoogle Scholar
  • 18 Ülkür E, Karagöz H, Uygur F, Çeliköz B. Serbest dorsoulnar perforatör flep ile parmak ucu onarımı: Olgu sunumu.  Turk J Plast Surg. 2006;  14 (1) 47-49
    PubMedGoogle Scholar
  • 19 Yabe T, Takahashi M, Kamano M. The free true perforator flap.  J Reconstr Microsurg. 2007;  23 (6) 329-333
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Chen S H, Xu D C, Tang M L, Ding H M, Sheng W C, Peng T H. Measurement and analysis of the perforator arteries in upper extremity for the flap design.  Surg Radiol Anat. 2009;  31 (9) 687-693
    CrossrefPubMedGoogle Scholar
  • 21 Kanellakos G W, Yang D, Morris S F. Cutaneous vasculature of the forearm.  Ann Plast Surg. 2003;  50 (4) 387-392
    CrossrefPubMedGoogle Scholar
  • 22 Yii N W, Niranjan N S. Fascial flaps based on perforators for reconstruction of defects in the distal forearm.  Br J Plast Surg. 1999;  52 (7) 534-540
    CrossrefPubMedGoogle Scholar
  • 23 Karacalar A, Ozcan M. Preliminary report: the distally pedicled dorsoulnar forearm flap for hand reconstruction.  Br J Plast Surg. 1999;  52 (6) 453-457
    CrossrefPubMedGoogle Scholar
  • 24 Ignatiadis I A, Xeinis S F, Tsiamba V A, Yiannakopoulos C K, Nomikos G N, Gerostathopoulos N E. Distal radial and ulnar arteries perforator-based adipofascial flaps for covering hand traumatic defects.  Microsurgery. 2007;  27 (5) 372-378
    CrossrefPubMedGoogle Scholar
  • 25 Rodriguez E D, Mithani S K, Bluebond-Langner R, Manson P N. Hand evaluation following ulnar forearm perforator flap harvest: a prospective study.  Plast Reconstr Surg. 2007;  120 (6) 1598-1601
    CrossrefPubMedGoogle Scholar
  • 26 Wong C, Ho P C, Tse W L, Cheng S, Chan D K, Hung L K. Do we need to repair the nerves when replanting distal finger amputations?.  J Reconstr Microsurg. 2010;  26 (5) 347-354
    Article in Thieme ConnectPubMedGoogle Scholar

Tekin SimsekM.D. 

Assistant Professor, Department of Plastic, Reconstructive and Aesthetic Surgery

Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey

Email: drtekinsimsek@hotmail.com