Background: Complex defects of the hand that expose tendons, bone, or neurovascular structures frequently require flap reconstruction. The dorsal ulnar flap is a fasciocutaneous flap based on the dorsal branch of the ulnar artery, first described by Becker and Gilbert in 1988. In its original description, the pedicle is not isolated, but the flap retains a cutaneous and subcutaneous base that includes the vascular axis, thus limiting its movement and arc of rotation. In this study, we propose a modification of the classical flap, with the skeletonization of the vascular pedicle up to its origin from the ulnar artery and the harvesting of a propeller flap. This approach allows for greater mobility, which is useful for the reconstruction of the palmar and dorsal surfaces of the hand, extending to the metacarpophalangeal (MCP) joints. Methods: We conducted a retrospective study on all patients who underwent reconstruction using the dorsal ulnar artery propeller flap between January 2014 and January 2022. The study included 12 patients; we described our surgical technique and reported the clinical outcomes, flap survival, and complications. Results: The average follow-up was 18 months. No major complications or complete flap necrosis were observed. Furthermore, no functional deficits were observed in the patients, and donor site morbidity was minimal. Conclusions: The dorsal ulnar artery propeller flap represents a valuable option for reconstructing small- to medium-sized defects of the hand and wrist that involve the volar and dorsal surfaces up to the MCP joints.
Mori et al. (Fri,) studied this question.