Thumb Ulnar Digital Artery Perforator Flap: An Alternative for Thumb and First Web Reconstruction
Aldo Giovanni Beltran-Pardo, MD/MSc, Edgar A Peñarrieta-Daher, MD, Dione L Castellanos-Villanueva, MD, Dulce M Sanchez-Dauth, MD, Mauricio M García-Pérez, MD/PhD, Nestor V Méndez-Huerta, MD and Pablo J Moreno-Peña, MD, Hospital Universitario de Nuevo Leon, Monterrey, NL, Mexico
The ulnar digital artery has constant cutaneous perforators along its pathway at the thumb's proximal phalanx. Based on previous research studies and author's clinical case series, we designed a flap based on these perforators to treat first web contractures. We now present the application of this ulnar digital artery perforator flap to resolve a proximal palmar flexion contraction of the thumb.
We present the case of a 21-year-old male with an interphalangeal and metacarpophalangeal thumb flexion contracture due to a past medical history of stab wound at the thumb's proximal phalanx requiring FPL reconstruction, 7 months previously. The oval shaped flap was marked at the thumb's proximal phalanx ulnar side and raised by sharp dissection until visualization of the ulnar collateral artery and its perforator branches through a palmar approach. This vessel yields cutaneous perforator branches in a curvilinear pathway form a ventromedial to a dorsolateral direction. It is unnecessary to skeletonize these perforators during dissection. This flap is usually displaced proximally to cover first web defects; however, in this case only one perforator was preserved to allow a 90º palmar pivot rotation to cover a large defect at the proximal phalanx of the thumb after release of its flexion contracture.
The patient underwent temporary K-wire interphalangeal fixation, oblique pulley reconstruction, FPL was grafted and reinserted with pull-out, as our ulnar digital perforator artery flap for proximal phalanx coverage; a full-thickness skin graft for donor site closure was necessary.
Clinical images of the flap's dissection, immediate post-op, and 3-week follow-up are presented with adequate flap color, position, and skin graft integration. No signs of infection, dehiscence, or flap necrosis were observed. The patient requires further follow-up to assess the contracture's long-term remission, to establish a different application of this flap originally described for first web contractures.
- Thumb's ulnar skin is perfused by constant ulnar digital artery perforators that ensure the flap's viability.
- This new perforator flap is a safe and reliable choice for moderate-sized first web reconstruction, which is usually intact in patients with hand burns.
- In this patient, we designed the same flap based only on a single ulnar artery perforator to release and treat a proximal thumb flexion contracture with adequate cosmesis and minimal donor site morbidity.
Beltran AG et al. The lateral proximal phalanx flap for contractures and soft tissue defects in the interphalangeal joint: An Anatomical and Clinical Study.
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