Reconstruction of Complex Finger Defects Using the Free Ulnar Artery Perforator Flap

Hand trauma and resections of tumors may create degloving injuries to the fingers leading to extensive and circumferential soft tissue defects that require a complex surgical management in terms of both skin coverage and functional outcomes. For this purpose, several local or locoregional flaps have been advocated in literature. Furthermore, good reconstructive results can be obtained by transferring soft tissue from the toes as well. Free tissue transfers are ordinarily indicated in case of major finger defects. Proximal ulnar perforator free flap represents a valid reconstructive option since it allows avoiding the most common drawbacks deriving from the use of the average free flaps. The authors report a case of a patient sustaining a complex hand trauma with underlying exposed structures covered with pliable, sensitive, and similar texture-matching skin harvested from the proximal volar forearm based on the proximal ulnar perforator. No vascular complications, wound dehiscence, or infections were observed. No cold intolerance was reported, and partial fine tactile sensibility was obtained. The patients showed good mobility and limited impairment in daily life activities. The overall cosmetic result was satisfying. Ulnar artery perforator free flap should be considered as a potentially superior alternative in digit reconstructive surgery. It can be harvested under single brachial plexus block, providing satisfactory functional and aesthetic results. Even though established microsurgical skills are required, the high reliability of its vascular anatomy and the low rate of neurovascular bundle injury during dissection make this flap feasible for the most hand surgeons.