J Reconstr Microsurg 2014; 30 - A026
DOI: 10.1055/s-0034-1373928

Treatment of Complex Hand Injuries Using the Dorsal Ulnar Artery Perforator Flap

Hiroyuki Gotani 1, 2, Yoshiki Yamano 1, 2, Koichi Yano 1, 2, Kosuke Sasaki 1, 2, YOshitaka Tanaka 1, 2, Masahiro Miyashita 1, 2
  • 1Osaka Trauma and Microsurgery Center, Seikeikai Hospital, Osaka, Japan
  • 2Department of Advance Clinical Medical Engineering, Shizuoka Science and Technology University, Shizuoka, Japan

Introduction: We recently have used dorsal ulnar artery perforator flaps (DUAPF) to cover the tendons and nerves during initial treatment as well as to repair soft tissue defects after elimination of cicatrices during secondary tenolysis and neurolysis in cases of complex hand injuries. The flap was first reported by Becker and Gilbert et al. and uses the dorsal ulnar artery as the pedicle.

Methodology and Material: The injury was caused by an electric saw in five patient, a press in eight patients, and so-called “spaghetti wrist” by self-laceration in two. The patients ranged in age from 16 to 47 years old (mean: 30 years). The DUAPF was used during the initial surgery in 6 patients and during secondary tenolysis or neurolysis in 9.

The vascular pedicle usually divides into three branches within the flexor carpi ulnaris muscle, and one of them is an ascending branch running proximally.

The flap was rotated once and was placed over the site of the soft tissue defect and scar elimination around the wrist, while covering the tendon and the nerves. In five patient, a vein in the flap was anastomosed with the cutaneous vein on the recipient site.

Results: The vascular pedicle could be identified in all cases. The postoperative results assessed according to Chen’s classification were Grade 3 in five patients, Grade 3 in four patients, and Grade 1 in six patients. A DUAPF was used as the pedicle flap in all cases, and as the fascial flap in three of them. Severe adhesion of the flap to the underlying tissues was not observed postoperatively, and none of the patients required re-operation.

Conclusions: Treatment of complex injuries becomes difficult if hard scar occurs at the site of the injury on the palmar side and the tendons or nerves adhere to the skin. It therefore seems best to use a flap with good circulation to cover the site in the early stage whenever possible. This technique, which uses a perforator that can be obtained from the same surgical field without sacrificing the main artery, is believed to be very useful.