The ulnar forearm fasciocutaneous flap (UFFF) is a favourable alternative to the radial forearm flap when thin and pliable tissue is required. The precise anatomy of the cutaneous perforators of UFFF has not been previously reported.
The position of cutaneous perforators >0.5 mm was recorded while raising 52 consecutive free UFFFs in 51 patients at our Centre.
Three (6%) UFFFs in two patients demonstrated direct cutaneous supply through a superficial ulnar artery, a known anatomic variance. There was no cutaneous perforator >0.5 mm in one flap. Among the remaining 48 dissections, an average of 3 (range, 1–6) cutaneous perforators were identified. Ninety-four percent of these forearms demonstrated at least one perforator >0.5 mm within 3 cm, and all had at least one perforator within 6 cm of the midpoint of the forearm. Proximal perforators were more likely to be musculo-cutaneous through the edge of flexor carpi ulnaris or flexor digitorum superficialis, while mid- to distal perforators were septo-cutaneous.
UFFF skin paddle designed to overlie an area within 3 cm of the midpoint between the medial epicondyle and the pisiform is most likely to include at least one cutaneous perforator from the ulnar artery, without a need for intra-operative skin island adjustment. This novel anatomic finding and other practical generalisations are discussed to facilitate successful elevation of UFFF.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Plastic, Reconstructive & Aesthetic Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- The distally based ulnar artery island flap in hand reconstruction.J Hand Surg (Br). 1997; 22: 204-211
- The free ulnar forearm flap.Ann Plast Surg. 1987; 18: 24-29
- The ulnar artery forearm free flap.Br J Plast Surg. 1984; 37: 486-492
- Donor site morbidity of free ulnar forearm flap.Head Neck. Published online 2 Nov 2011; https://doi.org/10.1002/hed.21943
- The ulnar artery free flap: the first 7 years.Plast Reconstr Surg. 1994; 93: 547-551
- The radial artery pedicle perforator flap: vascular analysis and clinical implications.Plast Reconstr Surg. 2010; 125: 1469-1478
- Hand evaluation following ulnar forearm perforator flap harvest: a prospective study.Plast Reconstr Surg. 2007; 120: 1598-1601
- The ulnar fasciocutaneous free flap in head and neck reconstruction.Laryngoscope. 2002; 112: 2155-2160
- Anatomy of the human body.20th ed. Lea & Febiger, Philadelphia and New York1918
- Brachial and antebrachial arterial patterns; a study of 750 extremities.Surg Gynecol Obstet. 1953; 96: 43-54
- Unusual variation of the ulnar artery.Anat Res. 1956; 124: 245-248
- Superficial ulnar artery flap.Plast Reconstr Surg. 1996; 97: 420-426
- The forearm flap.Clin Plast Surg. 1982; 9: 21-26
- Reducing morbidity in the radial forearm flap donor site.Plast Reconstr Surg. 1990; 86 (discussion 293–294): 287-292
- Radial forearm flap donor-site complications and morbidity: a prospective study.Plast Reconstr Surg. 1997; 99: 109-115
- The radial forearm flap: reconstructive applications and donor-site defects in 35 consecutive patients.Plast Reconstr Surg. 1990; 85: 258-266
- Complications of radial forearm flap donor sites.Br J Plast Surg. 1986; 39: 176-178
- Improving the donor site of the radial forearm flap.Br J Plast Surg. 1985; 38: 504-505
- The free radial forearm flap – the management of the secondary defect.Br J Plast Surg. 1987; 40: 83-85
- Refinement of the radial forearm flap donor site using skin expansion.Plast Reconstr Surg. 1988; 81: 21-25
- Closure of radial forearm free flap defect using full-thickness skin from the anterior abdominal wall.Br J Oral Maxillofac Surg. 1994; 32: 54-55
- Direct closure of the radial forearm flap donor defect.Br J Plast Surg. 1988; 41: 358-360
- Fascial flaps based on perforators for reconstruction of defects in the distal forearm.Br J Plast Surg. 1999; 52: 534-540
- Radial nerve morbidity in radial artery free flaps: harvest of cephalic vein versus venae comitantes.ANZ J Surg. 2005; 75: 542-545
- Analysis of digital pulse-volume recordings with radial and ulnar artery compression.Plast Reconstr Surg. 1998; 102: 1993-1998
- Superficial palmar arch: an arterial diameter study.J Anat. 2004; 204: 307-311
- Vascular dominance in the forearm.Plast Reconstr Surg. 2003; 111: 1891-1898
- Radial and ulnar artery dominance in normal digits.J Hand Surg (Am). 1989; 14: 504-508
- Comparison of ulnar and radial arterial blood-flow at the wrist.J Hand Surg (Br). 1995; 20: 240-242
Published online: April 16, 2012
Accepted: March 7, 2012
Received: December 30, 2011
☆This paper was presented, in part, at the Australian and New Zealand Head & Neck Cancer Society Annual Scientific Meeting, Brisbane, Australia, July 26–28, 2007.
© 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.