The Clinical Application Of The Ulnar Artery Proximal Perforator Free Flap In The Complex Hand Defect Reconstruction

OBJECTIVE: To provide a good solution for complex hand wounds by using the ulnar artery proximal perforator free flap.METHODS: From May 2010 to August 2013,our department repaired small and medium-sized wounds of the hand using the ulnar artery proximal perforator free flap.Among them,all 9 cases were successful.Six patients were male,and the remaining three were female,with an average age of 37 years.The minimum area of the wound is 2 x 1.5 cm and the maximum area is 12 x 6 cm.Three cases were wringer injury,three were chainsaw injury,two were belt twist,and one was high-pressure blast injury.Three cases had phalangeal fracture and tendon injury.Five cases were soft tissue defect with tendon exposed.After thorough debridement,eight cases of flap achieved the purpose of repairing wounds in the first stage.One case of flap experienced a venous thrombosis 2 days post operation,which survived after exploration and re-anastomosis.RESULTS: All 9 flaps were successful.The average time in hospital was 27 days.Nine patients were satisfied with the appearance of the flap.At 6 months after operation,the flap gradually recovered its sensation.There were tactile,painful,and two-point discrimination in the flap.The average two-point discrimination was 9.20±1.80 mm.Conclusion: The proximal ulnar artery flap is similar to the soft tissue of the hand,which has certain advantages for complex hand soft tissue defects.This flap does not carry deep fascia,providing a thin soft tissue coverage.It has a good appearance and texture.Particularly,when it is applied in tiny soft tissue defect repair,its donor area can be directly closed,showing no need for skin grafting.We believe it is a good choice in the repair of the hand soft tissue defect.