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Cadaveric Study: Detailed Intra-flap Perforator Anatomy of the Dorsal Ulnar Artery Perforator Flap (Becker Flap)
Hui Qi Crystalline Lim, BSc1; Sze Wei Justin Lee, MbChB1; Quentin A. Fogg BSc, PhD2; Andrew M. Hart, MD, PhD, FRCS3
1School of Medicine, University of Glasgow, Glasgow, United Kingdom; 2Laboratory of Human Anatomy, University of Glasgow, Glasgow, United Kingdom, 3Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow, United Kingdom

Introduction and Aims: The dorsal ulnar artery perforator flap (Becker flap) was first described by Becker and Gilbert (1988) and has then been reported to be ideal for soft tissue reconstruction of small to medium sized defects of the hand. Although this perforator flap is in current use, it is still raised without full application of the perforator paradigm. The Becker flap, anatomically, is a perforator flap but is still tend to be raised with fascia. The aim of this anatomical study sets out to establish the intra-flap anatomy of the key perforators, and to better define the pattern of arborisation into the subdermal plexus and to permit safe primary thinning during transfer. Additionally, the relative contribution of deep fascia to the vascular perfusion territory of the Becker flap will be assessed.

Material and Methods: 5 embalmed cadaveric Becker flaps were cannulated with latex dye and dissected to show the perforating branches of the ulnar artery. All flaps underwent tissue clearing using Spalteholz technique. Pictures were taken for each specimen and were analysed using Image J 1.46r. Several measurements of the flap and its respective perforators with regards to the entry points into the subdermal plexus were noted.

Results: The value of the means were as follows: Flap length = 10.3 0.9 cm, Width = 4.2 1.4 cm, number of dorsal ulnar artery perforators = 2, Perforator diameter = 1.06 0.11 mm, Perforator length = 3.11 0.24 cm. There are 2 major-branch distributions of the perforators and the perforators were noted to arborise before entering the deep subcutaneous tissue. The perforator entry points into the subdermal plexus were variable. Using the vertical axis (pisiform as mid-point), all perforators were located within 25 35% of this flap. Using the horizontal axis (pisiform towards medial olecranon), perforators ascend distally, entering the subdermal plexus within 10 30% of this flap.

Conclusion: The axes are useful guides as it serves as a good surgical indicator as to where the danger zone (10 35%) is located. This cadaveric study on intra-flap perforator anatomy showed that deep fascia contributes to the vascular territory of the Becker flap.

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