Skip to main content
Top
Published in: Surgical and Radiologic Anatomy 8/2013

01-10-2013 | Anatomic Bases of Medical, Radiological and Surgical Techniques

The little finger ulnar palmar digital artery perforator flap: anatomical basis

Authors: Francesca Toia, Marcella Marchese, Barbara Boniforti, Pierluigi Tos, Luca Delcroix

Published in: Surgical and Radiologic Anatomy | Issue 8/2013

Login to get access

Abstract

Purpose

The aim of this study was to explore the cutaneous vascularization of the hypothenar region and investigate the anatomical basis for perforator propeller flaps for coverage of the flexor aspect of the little finger.

Methods

The area between the pisiform and the base of the little finger was studied in 14 hands of fresh cadavers injected with red latex. An oval flap 1.5 cm large was raised along the axis between these two points. Perforators going into the flap were dissected up to their origin from the ulnar palmar digital artery of the little finger, and their distance from the proximal edge of the A1 pulley was recorded.

Results

The mean number of perforator arteries entering the flap was 5.8 (range 4–8). A constant sizeable perforator was identified within 0.7 cm from the proximal margin of the A1 pulley in all 14 specimens. In the majority of cases (64 %), the most distal perforator was located at this level. Dissection of the flap was carried out suprafascially on the most distal perforator and 180° rotation allowed the flap to reach the flexor surface of the fifth finger. The donor site was closed primarily.

Conclusion

Distal perforators of the ulnar palmar digital artery of the little finger are constantly found. Our anatomical findings support the possibility of raising a propeller perforator flap from the hypothenar region for coverage of the flexor aspect of the little finger. Its clinical application could provide a quick and straightforward single-stage option with a negligible donor-site morbidity for reconstruction of such defects.
Literature
1.
go back to reference Casoli V, Vérolino P, Pélissier P, Kostopoulos E, Caix P, Delmas V, Martin D, Baudet J (2004) The retrograde neurocutaneous island flap of the dorsal branch of the ulnar nerve: anatomical basis and clinical application. Surg Radiol Anat 26(1):8–13PubMedCrossRef Casoli V, Vérolino P, Pélissier P, Kostopoulos E, Caix P, Delmas V, Martin D, Baudet J (2004) The retrograde neurocutaneous island flap of the dorsal branch of the ulnar nerve: anatomical basis and clinical application. Surg Radiol Anat 26(1):8–13PubMedCrossRef
5.
go back to reference Hwang K, Han JY, Chung IH (2005) Hypothenar flap based on a cutaneous perforator branch of the ulnar artery: an anatomic study. J Reconstr Microsurg 21(5):297–301PubMedCrossRef Hwang K, Han JY, Chung IH (2005) Hypothenar flap based on a cutaneous perforator branch of the ulnar artery: an anatomic study. J Reconstr Microsurg 21(5):297–301PubMedCrossRef
6.
go back to reference Kinoshita Y, Kojima T, Hirase Y, Kim H, Endo T (1991) Subcutaneous pedicle hypothenar island flap. Ann Plast Surg 27(6):519–526PubMedCrossRef Kinoshita Y, Kojima T, Hirase Y, Kim H, Endo T (1991) Subcutaneous pedicle hypothenar island flap. Ann Plast Surg 27(6):519–526PubMedCrossRef
7.
go back to reference Kojima T, Endo T, Fukumoto K (1990) Reverse vascular pedicle hypothenar island flap. Handchir Mikrochir Plast Chir 22(3):137–144PubMed Kojima T, Endo T, Fukumoto K (1990) Reverse vascular pedicle hypothenar island flap. Handchir Mikrochir Plast Chir 22(3):137–144PubMed
8.
go back to reference Morris SF, Miller BJ, Taylor GI (2006) Vascular anatomy of the integument. In: Blondeel PN, Morris SF, Hallock GG, Neligan PC (eds) Perforators flaps anatomy, technique and clinical applications, vol I. Quality Medical Publishing Inc., St. Louis, pp 11–36 Morris SF, Miller BJ, Taylor GI (2006) Vascular anatomy of the integument. In: Blondeel PN, Morris SF, Hallock GG, Neligan PC (eds) Perforators flaps anatomy, technique and clinical applications, vol I. Quality Medical Publishing Inc., St. Louis, pp 11–36
9.
go back to reference Nagoshi M, Hashizume H, Nishida K, Takagoshi H, Pu J, Inoue H (1997) Percutaneous release for trigger finger in idiopathic and hemodialysis patients. Acta Med Okayama 51:155–158PubMed Nagoshi M, Hashizume H, Nishida K, Takagoshi H, Pu J, Inoue H (1997) Percutaneous release for trigger finger in idiopathic and hemodialysis patients. Acta Med Okayama 51:155–158PubMed
10.
go back to reference Novelino F, Goncalves J, de l’Aulnoit SH, Schoofs M (2002) The fasciocutaneous hypothenar flap: preliminary anatomical and clinical study. Ann Chir Plast Esthet 47(1):9–11PubMedCrossRef Novelino F, Goncalves J, de l’Aulnoit SH, Schoofs M (2002) The fasciocutaneous hypothenar flap: preliminary anatomical and clinical study. Ann Chir Plast Esthet 47(1):9–11PubMedCrossRef
11.
go back to reference Omokawa S, Yajima H, Inada Y, Fukui A, Tamai S (2010) A reverse ulnar hypothenar flap for finger reconstruction. Plast Reconstr Surg 106(4):828–833 Omokawa S, Yajima H, Inada Y, Fukui A, Tamai S (2010) A reverse ulnar hypothenar flap for finger reconstruction. Plast Reconstr Surg 106(4):828–833
12.
go back to reference Omokawa S, Ryu J, Tang JB, Han JS (1996) Anatomical basis for a fasciocutaneous flap from the hypothenar eminence of the hand. Br J Plast Surg 49(8):559–563PubMedCrossRef Omokawa S, Ryu J, Tang JB, Han JS (1996) Anatomical basis for a fasciocutaneous flap from the hypothenar eminence of the hand. Br J Plast Surg 49(8):559–563PubMedCrossRef
15.
go back to reference Plancher KD, Idler RS, Lourie GM, Strickland JW (1996) Recalcitrant carpal tunnel. The hypothenar fat pad flap. Hand Clin 12(2):337–349PubMed Plancher KD, Idler RS, Lourie GM, Strickland JW (1996) Recalcitrant carpal tunnel. The hypothenar fat pad flap. Hand Clin 12(2):337–349PubMed
16.
go back to reference Uchida R, Matsumura H, Imai R, Tanaka K, Watanabe K (2009) Anatomical study of the perforators from the ulnar palmar digital artery of the little finger and clinical uses of digital artery perforator flaps. Scand J Plast Reconstr Surg Hand Surg 43(2):90–93. doi:10.1080/02844310802556976 PubMedCrossRef Uchida R, Matsumura H, Imai R, Tanaka K, Watanabe K (2009) Anatomical study of the perforators from the ulnar palmar digital artery of the little finger and clinical uses of digital artery perforator flaps. Scand J Plast Reconstr Surg Hand Surg 43(2):90–93. doi:10.​1080/​0284431080255697​6 PubMedCrossRef
17.
go back to reference Wilhelmi BJ, Snyder N, Verbesey JE, Ganchi PA, Lee WPA (2001) Trigger finger release with hand surface landmark ratios: an anatomic and clinical study. Plast Reconstr Surg 108:908–915PubMedCrossRef Wilhelmi BJ, Snyder N, Verbesey JE, Ganchi PA, Lee WPA (2001) Trigger finger release with hand surface landmark ratios: an anatomic and clinical study. Plast Reconstr Surg 108:908–915PubMedCrossRef
Metadata
Title
The little finger ulnar palmar digital artery perforator flap: anatomical basis
Authors
Francesca Toia
Marcella Marchese
Barbara Boniforti
Pierluigi Tos
Luca Delcroix
Publication date
01-10-2013
Publisher
Springer Paris
Published in
Surgical and Radiologic Anatomy / Issue 8/2013
Print ISSN: 0930-1038
Electronic ISSN: 1279-8517
DOI
https://doi.org/10.1007/s00276-013-1091-7

Other articles of this Issue 8/2013

Surgical and Radiologic Anatomy 8/2013 Go to the issue