Dorsal Ulnar Artery Perforator Based Flap For Coverage of Composite Soft Tissue Defects of Hand

Hyder Ali, Mariam Noor, Sabeen Hyder, Mujtuba Pervez, Waqas Sami

Abstract

Objective

To describe the usefulness of dorsal ulnar artery perforator flap for coverage of composite soft tissue defects of the hand.

Study design

Descriptive case series.

Place & Duration of study

Department of Plastic and Reconstructive surgery, Dow University of Health Sciences & Dr. Ruth KM Pfau Civil Hospital Karachi, from  June 2018 to September 2019.

Methodology

Patients with composite soft tissue defects of hand were selected. Patients with segmental bone loss and severe co-morbid conditions were excluded. After initial debridement of the defect, perforator was identified with Doppler ultrasound. Flap was raised from proximal to distal direction with deep fascia and inset into the defect. Donor sites were skin grafted in all cases. Patients were followed for three months postoperatively.

Results

Total 15 patients with composite soft tissue defects of hand were operated. Mean age of the patients was 22.9 year. In seven patients flap was used to cover the defect on the dorsum of hand, in five for palm, in two for wrist, and one for first web space. In 12 patients healing occurred uneventfully. Partial necrosis was found in one flap which was later skin grafted. Superficial epidermolysis and mild wound site infection was found in one case each and both were managed conservatively. Donor site graft take was 100% and the eventual result was acceptable to the patients.

Conclusion

Perforator based dorsal ulnar artery flap is an easy, reliable and single stage option for coverage of composite soft tissue defects of the hand.

Key words •

Composite hand injuries, Ulnar artery perforator flap, Soft tissue coverage of hand.